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Surgical results and functional outcome after total anorectal reconstruction by double graciloplasty supported by external-source electrostimulation and/or implantable pulse generators: an 8-year experience

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Surgical and functional results after abdominoperineal resection and total anorectal reconstruction by electrostimulated gracilis muscle transposition are still poorly documented. This study prospectively evaluated surgical and functional outcome over time in our patients.

Patients and methods

Twenty-three patients underwent abdominoperineal resection, coloperineal pullthrough, double graciloplasty, and loop abdominal stoma. Temporary external-source intermittent electrostimulation, biofeedback training, and selective delayed stimulator implantation to improve unsatisfactory results were carried out in the first 13 patients (1st series); thereafter (2nd series) the stimulator was implanted during graciloplasty. Surgical and oncological results were followed up in all patients. Functional results were evaluated in 16 patients who underwent abdominal stoma takedown, eight in each of the two series, by anomanometry (up to 1 year) and our own 0–20 scoring system (up to 8 years from initial surgery).

Results

The rate of major and minor postoperative complications was 21.7% and 65%, respectively. Continuous electrostimulation proved effective on resting anal pressure. Early clinical assessments showed satisfactory functional results (considered as having a score ≤8) in all first-group patients, including five who had stimulator support, and in one-half of second-group patients. After impairment (at least 2 points) at 1 year in five patients, four of whom were from the first group, all functional results improved and became satisfactory from 5 years on (1st series) and from 4 years on (2nd series).

Conclusion

Despite marked morbidity the high rate of good results, which improved over time, suggests that total anorectal reconstruction is worth being performed as part of abdominoperineal resection in well-selected patients with a strong motivation to avoid a permanent colostomy.

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Acknowledgement

This study was supported in part by grants from the Italian Ministero dell’Università e della Ricerca Scientifica e Tecnologica.

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Authors and Affiliations

  1. Department of Surgical Sciences, General Surgery Clinic, University of Parma Medical School, Via Gramsci 14, 43100, Parma, Italy

    Vincenzo Violi, Adamo S. Boselli, Massimo De Bernardinis, Renato Costi & Luigi Roncoroni

  2. Gastroenterology Unit, Department of Internal Medicine, Parma Hospital, Parma, Italy

    Giorgio Nervi, Anna Bertelè & Angelo Franzè

Authors
  1. Vincenzo Violi
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  2. Adamo S. Boselli
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  3. Massimo De Bernardinis
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  4. Renato Costi
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  5. Giorgio Nervi
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  6. Anna Bertelè
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  7. Angelo Franzè
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  8. Luigi Roncoroni
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Correspondence to Vincenzo Violi.

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Violi, V., Boselli, A.S., De Bernardinis, M. et al. Surgical results and functional outcome after total anorectal reconstruction by double graciloplasty supported by external-source electrostimulation and/or implantable pulse generators: an 8-year experience. Int J Colorectal Dis 19, 219–227 (2004). https://doi.org/10.1007/s00384-003-0528-6

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  • DOI: https://doi.org/10.1007/s00384-003-0528-6

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