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Current aspects and future prospects of total anorectal reconstruction—a critical and comprehensive review of the literature

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Abstract

Purpose

Many rectal cancer patients undergo abdominoperineal excision worldwide every year. Various procedures to restore perineal (pseudo-) continence, referred to as total anorectal reconstruction, have been proposed. The best technique, however, has not yet been defined. In this study, the different reconstruction techniques with regard to morbidity, functional outcome and quality of life were analysed. Technical and timing issues (i.e. whether the definitive procedure should be performed synchronously or be delayed), oncological safety, economical aspects as well as possible future improvements are further discussed.

Methods

A MEDLINE and EMBASE search was conducted to identify the pertinent multilingual literature between 1989 and 2013. All publications meeting the defined inclusion/exclusion criteria were eligible for analysis.

Results

Dynamic graciloplasty, artificial bowel sphincter, circular smooth muscle cuff or gluteoplasty result in median resting and squeezing neo-anal pressures that equate to the measurements found in incontinent patients. However, quality of life was generally stated to be good by patients who had undergone the procedures, despite imperfect continence, faecal evacuation problems and a considerable associated morbidity. Many patients developed an alternative perception for the urge to defecate that decisively improved functional outcome. Theoretical calculations suggested cost-effectiveness of total anorectal reconstruction compared well to life with a permanent colostomy.

Conclusions

Many patients would be highly motivated to have their abdominal replaced by a functional perineal colostomy. Given the considerable morbidity and questionable functional outcome of current reconstruction technique improvements are required. Tissue engineering might be an option to design an anatomically and physiologically matured, and customised continence organ.

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Conflict of interest

None of the authors have any potential conflicts of interest, relevant financial interests, activities, relationships and affiliations with respect to this publication to declare.

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Authors and Affiliations

  1. Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010, Bern, Switzerland

    Roman A. Inglin, Lukas E. Brügger & Daniel Candinas

  2. Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Sternwartstrasse 14, CH-8091 Zurich, Switzerland

    Daniel Eberli & Tullio Sulser

  3. National Centre for Bowel Research and Surgical Innovation, Barts and The London School of Medicine and Dentistry, The Royal London Hospital, 2 Newark Street, London E1 2 AT, UK

    Norman S. Williams

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  1. Roman A. Inglin
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  2. Daniel Eberli
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Correspondence to Roman A. Inglin.

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Inglin, R.A., Eberli, D., Brügger, L.E. et al. Current aspects and future prospects of total anorectal reconstruction—a critical and comprehensive review of the literature. Int J Colorectal Dis 30, 293–302 (2015). https://doi.org/10.1007/s00384-014-2065-x

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