Abstract
PURPOSE: Chronic low-frequency electrical stimulation can safely transform fatiguing muscle into fatigue-resistant muscle. This fundamental discovery was used to reconstruct the anal sphincter. Dynamic graciloplasty was found to be effective in the treatment of fecal incontinence. Our study was undertaken to investigate the oncologic, functional, and quality of life results of dynamic graciloplasty anal reconstruction after an abdominoperineal resection for carcinoma. METHODS: Between April 1993 and April 1996, nine patients (4 males) with a median age of 51.2 (range, 29–69) years underwent an abdominoperineal resection for carcinoma (4 had a rectal adenocarcinoma and 5 had an epidermoidal anal tumor) and an anal sphincter reconstruction with electrically stimulated graciloplasty. Oncologic and functional results were evaluated after a mean follow-up of 32 (range, 14–59) months. A quality of life questionnaire was filled out by seven patients. RESULTS: Sphincter reconstruction required the same hospitalization period as abdominoperineal resection. Two patients died from evolutive disease. Three patients were operated on twice, one for immediate colonic necrosis, two for colonic perforation after enema. One of them refused the graciloplasty and had an abdominoperineal resection. Six patients were dysfunctioned. The mean resting pressure was 24±10 mmHg, and the mean pressure during stimulation was 95±25 mmHg. Five patients were continent for solids and liquid; four wore less than three pads per day, and one wore more than three. Four patients used enemas twice a week; one patient had spontaneous evacuation. The quality of life questionnaire showed that the mean scores for social interaction, symptoms, and psychological and physical states were 2.1, 2.2, 2.4, and 2.7, respectively. The mean value was 1.5 CONCLUSIONS: Total anorectal reconstruction with dynamic graciloplasty is an oncologically safe procedure. Functional results improve with time, but careful patient selection guarantees a successful functional outcome. Technical progress is necessary to improve the quality of life.
Similar content being viewed by others
References
Pickrell KL, Broadbent TR, Masters FW, Metzger JL. Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle: a report of four cases in children. Ann Surg 1952;139:853–63.
Salmons S, Vrbova G. The influence of activity on some contractile characteristics of mammalian fast and slow muscles. J Physiol 1969;201:535–49.
Baeten C, Spaans F, Fluks A. An implanted neuromuscular stimulator for fecal incontinence following previously implanted gracilis muscle: report of a case. Dis Colon Rectum 1988;31:134–7.
Williams NS, Patel J, George BD,et al. Development of an electrically stimulated neoanal sphincter. Lancet 1991;338:1166–9.
Williams NS, Hallan RI, Koeze TH, Watkins ES. Restoration of gastrointestinal continuity and continence after abdominoperineal excision of the rectum using an electrically stimulated neoanal sphincter. Dis Colon Rectum 1990;33:561–5.
Cavina E, Seccia M, Evangelista G,et al. Construction of a continent perineal colostomy by using electrostimulated gracilis muscles after abdominoperineal resection: personal technique and experience with 32 cases. It J Surg Sci 1987;17:305–14.
Chwalow AJ, Lurie A, Bean K,et al. A french version of the sickness impact profile: stages in the cross cultural validation of a generic quality of life scale. Fundal Clin Pharmacol 1992;6:319–26.
Minsky BD. Adjuvant therapy for rectal cancer. A good first step. N Engl J Med 1997;336:1016–7.
Rouanet P, Fabre JM, Dubois JB,et al. Conservative surgery for low rectal carcinoma after high-dose radiation: functional and oncologic results. Ann Surg 1995;221:67–73.
Deans GT, McAleer JJ, Spence RA. Malignant anal tumours. Br J Surg 1994;81:501–8.
Mander BJ, Abercrombie JF, George BD, Williams NS. The electrically stimulated gracilis neosphincter incorporated as part of total anorectal reconstruction after abdominoperineal excision of the rectum. Ann Surg 1996;224:702–11.
Seccia M, Menconi C, Balestri R, Cavina E. Study protocols and functional results in 86 electrostimulated graciloplasties. Dis Col Rectum 1994;37:897–904.
Geerdes BP, Zoetmulder FA, Heineman E, Vos EJ, Rongen MJ, Baeten CG. Total anorectal reconstruction with a double dynamic graciloplasty after abdominoperineal reconstruction for low rectal cancer. Dis Colon Rectum 1997;40:698–705.
Cavina E. Outcome of restorative perineal graciloplasty with simultaneous excision of the anus and rectum for cancer: a ten-year experience with 81 patients. Dis Colon Rectum 1996;39:182–90.
Santoro E, Tirelli C, Scutari F,et al. Continent perineal colostomy by transposition of gracilis muscles: technical remarks and results in 14 cases. Dis Colon Rectum 1994;37(Suppl):S73-S80.
Wee TK, Wong SK. Functional anal sphincter reconstruction with the gracilis muscles after abdominoperineal resection. Lancet 1984;2:1245–6.
Rosen HR, Feil W, Novi G,et al. The electrically stimulated (dynamic) graciloplasty for faecal incontinencefirst experiences with a modified muscle sling. Int J Colorectal Dis 1994;9:184–6.
Mercati U, Trancanelli V, Castagnoli GP, Mariotti A, Ciaccarini R. Use of the gracilis muscles for sphincteric construction after abdominoperineal resection: technique and preliminary results. Dis Colon Rectum 1991;34:1085–9.
Simonsen OS, Stolf NA, Aun F,et al. Rectal sphincter reconstruction in perineal colostomies after abdominoperineal resection for cancer. Br J Surg 1976;63:389–91.
Graf W, Ekström K, Glimelius B, Påhlman L. A pilot study of factors influencing bowel function after colorectal anastomosis. Dis Colon Rectum 1996;39:744–9.
Geerdes BP, Zoetmulder FA, Baeten CG. Double dynamic graciloplasty and coloperineal pull-through after abdominoperineal resection. Eur J Cancer 1995;31A:1248–52.
Von Flue MO, Degen LP, Beglinger C,et al. Ileocecal reservoir reconstruction with physiologic function after total mesorectal cancer excision. Ann Surg 1996;224:204–12.
Frigell A, Ottander M, Stenbeck H, Påhlman L. Quality of life of patients treated with abdominoperineal resection or anterior resection for rectal carcinoma. Ann Chir Gynaecol 1990;79:26–30.
Author information
Authors and Affiliations
Additional information
Supported by a grant from the Ligue Contre le Cancer, Comité de l'Hérault et de l'Aveyron, and the Comité de Lutte contre le Cancer de Ginestas, France.
About this article
Cite this article
Rouanet, P., Senesse, P., Bouamrirene, D. et al. Anal sphincter reconstruction by dynamic graciloplasty after abdominoperineal resection for cancer. Dis Colon Rectum 42, 451–456 (1999). https://doi.org/10.1007/BF02234165
Issue Date:
DOI: https://doi.org/10.1007/BF02234165