Anorectal reconstruction by colo-perineal anastomosis and dynamic double graciloplasty after abdominoperitoneal resection.

The aim of this study was to assess the technical and functional results of total anorectal reconstruction with double dynamic graciloplasty after abdominoperineal resection (APR). Patients and method's. From May 1995 to December 1996, 10 patients (6 males and 4 females), with a mean age of 54 years (range 39-74), underwent anorectal reconstruction for low rectal adenocarcinoma. All patients had preoperative radiotherapy and six had postoperative chemotherapy. The surgical procedure was performed in three stages: 1) APR, coloperineal anastomosis, double graciloplasty and ileostomy; 2) three months later, implantation of stimulator and leads; 3) after a two-months training period, the stoma was closed. Results. There was no postoperative mortality. Early and late morbidity occurred in 5 patients : 2 colonic fistulas, 1 necrosis of colon, 1 ileostomy prolapse, 1 neosphincter stenosis, 1 sepsis of stimulator. No patient had recurrence of the disease (mean follow-up 16 months), but two patients died at 3 and 8 months, respectively from anorexia and pulmonary embolism, Seven patients were available for evaluation (2 fistula, 1 death). Before training, the resting pressure and the squeeze pressure were 30 and 175 cm H2O respectively. At the time of evaluation, the electrical stimulated pressure was 95 cm H2O. Six of these 7 patients were continent (5 with spontaneous defecation, 1 with enemas) and 1 was incontinent. Conclusions: Anorectal reconstruction with dynamic graciloplasty can be an alternative to permanent colostomy for selected patients after APR. However, there is a high morbidity and the quality of life of the patients must be evaluated.