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International Journal of Colorectal Disease

, Volume 30, Issue 3, pp 293–302 | Cite as

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

  • Roman A. InglinEmail author
  • Daniel Eberli
  • Lukas E. Brügger
  • Tullio Sulser
  • Norman S. Williams
  • Daniel Candinas
Review

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.

Keywords

Total anorectal reconstruction TAR Colorectal cancer Abdominoperineal excision APER 

Notes

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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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Roman A. Inglin
    • 1
    Email author
  • Daniel Eberli
    • 2
  • Lukas E. Brügger
    • 1
  • Tullio Sulser
    • 2
  • Norman S. Williams
    • 3
  • Daniel Candinas
    • 1
  1. 1.Department of Visceral Surgery and MedicineBern University Hospital, University of BernBernSwitzerland
  2. 2.Laboratory for Tissue Engineering and Stem Cell Therapy, Department of UrologyUniversity Hospital ZurichCH-8091 ZurichSwitzerland
  3. 3.National Centre for Bowel Research and Surgical InnovationBarts and The London School of Medicine and Dentistry, The Royal London HospitalLondon E1 2 ATUK

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