Dubbele dynamische M. gracilis-plastiek: alternatief voor een colostoma na een volledig verlies van het anorectum

Evaluation of the technique of total anal reconstruction by double dynamic graciloplasty after total loss of the anorectum.

Design

Prospective pilot study.

Setting

Academic Medical Hospital, Maastricht and National Cancer Institute, the Netherlands.

Method

In 14 patients with a low rectal carcinoma who had to undergo an abdominoperineal resection and in two patients who lost their anorectum due to a severe perineal trauma a coloperineal pull-through operation was performed with creation of a new pelvic floor and anal sphincter by means of a double graciloplasty. Eight weeks later two electrodes and a neurostimulator were implanted for dynamisation. All patients had a temporary protective ileostomy.

Results

After a mean follow-up of 2.1 years nine patients (56) had become continent while four patients were still in training (25). In three patients the therapy failed, in two due to necrosis of the colon stump; a definite colostomy was created. Of the patients who already completed the treatment (n = 12) nine patients were continent (75) while the method had failed in three patients (25). There were no local recurrences; in three patients there were distant metastases.

Conclusion

Total anal reconstruction by means of a double dynamic graciloplasty is an oncologically safe procedure with a good functional result. By preventing a colostomy this method could improve the quality of life.