Advertisement

Laparoscopic sphincter reconstruction after abdominoperineal resection: feasibility and technical aspects

  • H. Albrecht
  • S. GretschelEmail author
Technical Note
  • 20 Downloads

Abstract

Background

Abdominal colostomy has been reported as an option with good quality of life for patients requiring abdominoperineal resection (APR) for very low rectal cancer. Some young, compliant patients, nevertheless, are very motivated to avoid abdominal colostomy following APR. Spiral smooth muscle cuff perineal colostomy as neosphincter reconstruction can be a reasonable alternative. We have published before the results of a series of sphincter reconstruction in the conventional technique following APR. As we developed our technique for colorectal resection sphincter reconstruction, we also changed to a laparoscopic approach.
 The aim of the present study was to evaluate the feasibility of laparoscopic neosphincteric reconstruction and outline the aspects of the technique.

Methods

This retrospective study was conducted on 15 patients treated at our institution during a 6 year period for low rectal cancer by laparoscopic APR and spiral smooth muscle cuff perineal colostomy as sphincter reconstruction. At follow-up at a median time of 3.7 years (range 3–9 years) after surgery, patients underwent functional evaluation which included the modified Holschneider continence score (0–16), assessing consistency of stool, frequency, impulse, discrimination, warning period, incontinence for formed or fluid feces, soiling, wearing pads, drugs, enema where a score of 13–16 is associated with normal continence, as well as neosphincter manometry.

Results

Laparoscopic sphincter reconstruction was feasible in all 15 patients. Two of the fifteen patients (13%) required secondary colostomy in the long term due to neosphincter malfunction and neosphincter perforation after enema. Four of the remaining thirteen patients (30%) were partially continent according to the Holschneider continence score (HCS) with a score of 7–12. The other 9 (70%) were continent (HCS: 13–16). Neosphincter manometry showed a median resting pressure of 33 cm H2O (range 30–41 cm H2O) and a median squeeze pressure of 95 cm H2O (range 84–150 cm H2O).

Conclusions

Laparoscopic sphincter reconstruction following APR is a feasible option offering an alternative to abdominal colostomy for selected patients.

Keywords

Sphincter reconstruction Neosphincter Perineal colostomy Rectal cancer Laparoscopic Abdominoperineal resection 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the international and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

References

  1. 1.
    Federov VD, Odaryuk TS, Shelygin YA, Tsarkov PV, Frolov SA (1989) Method of creation of a smooth-muscle cuff at the site of the perineal colostomy after extirpation of the rectum. Dis Colon Rectum 32:562–566CrossRefGoogle Scholar
  2. 2.
    Schlag PM, Slisow W, Moesta KT (1998) Seromuscular spiral cuff perineal colostomy: an alternative to abdominal wall colostomy after abdominoperineal excision for rectal cancer. Recent Results Cancer Res 146:95–103CrossRefGoogle Scholar
  3. 3.
    Gamagami RA, Chiotasso P, Lazorthes F (1999) Continent perineal colostomy after ab dominoperineal resection: outcome after 63 cases. Dis Colon Rectum 42:626–630CrossRefGoogle Scholar
  4. 4.
    Hirche C, Mrak K, Kneif S et al (2010) Perineal colostomy with spiral smooth muscle graft for neosphincter reconstruction following abdominoperineal resection of very low rectal cancer: long-term outcome. Dis Colon Rectum 53(9):1272–1279CrossRefGoogle Scholar
  5. 5.
    Holschneider AM (1983) Treatment and functional results of anorectal continence in children with imperforate anus. Acta Chir Belg 82:191–204Google Scholar
  6. 6.
    Herold A, Bruch HP (1996) Staged diagnosis of anorectal incontinence [in German]. Zentralbl Chir 121:632–638Google Scholar
  7. 7.
    Romano G, LaTorre F, Cutini G, Bianco F, Esposito P, Montori A (2003) Total anorectal recon struction with the artificial bowel sphincter: report of eight cases. A quality-of-life assessment. Dis Colon Rectum 46:730 – 734CrossRefGoogle Scholar
  8. 8.
    Schmidt E, Bruch HP, Greulich M et al (1979) Continent colostomy through free transplanta tion of autologous colon muscles [in German]. Chirurg 50:96–100Google Scholar
  9. 9.
    Pescatori M, Spyrou M, Bilali S et al (2005) Low anterior intersphincteric resection, total mesorectal excision, coloplasty and coloanal anastomosis with neoanal smooth muscle encir clement for low rectal cancer. Tech Coloproctol 9:185CrossRefGoogle Scholar
  10. 10.
    Pocard M, Sideris L, Zenasni F et al (2007) Functional results and quality of life for patients with very low rectal cancer undergoing coloanal anastomosis or perineal colostomy with colo nic muscular graft. Eur J Surg Oncol 33:459–462CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of General and Visceral Surgery, Brandenburg Medical SchoolUniversity Hospital NeuruppinNeuruppinGermany

Personalised recommendations