Abstract
PURPOSE: The aim of this study was to describe and discuss the anosphincter-restoring procedure adopted in an adult patient with rectal cancer, affected by anorectal atresia and rectovestibular fistula not previously treated. METHODS: After anterior resection and transverse dissection of the rectovaginal septum, a straight double-staple low colorectal anastomosis was performed. A subcutaneous tunnel was extended from the inter-rectovaginal space, surrounding the pseudoanal orifice. The tunnel housed a left gracilis muscle arranged counter-clockwise and connected to an implanted stimulator. The vaginal and anorectal flaps were sutured longitudinally, thereby spacing out the two orifices and creating an anorectal angle. A temporary loop right colostomy was performed. RESULTS: The postoperative course was uneventful. After continuous electrostimulation training and colostomy takedown, the patient had improved continence (stimulator on) and normal defecation (stimulator off). CONCLUSIONS: The solution described seemed a suitable alternative to a pull-through procedure, which would have involved a colocutaneous anastomosis and the loss of the anorectal sensory function. Any previous anal transposition or pull-through procedures would have prevented the saving of the pre-existing “anus,” because of the interruption of the residual mesenteric vascular supply to the anorectal remnant secondary to mesorectal excision.
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Supported in part by grants from the Ministero dell'Università e della Ricerca Scientifica e Tecnologica, Repubblica Italiana.
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Violi, V., Boselli, A.S., Sarli, L. et al. Rectal cancer in anorectal malformation with rectovestibular fistula. Dis Colon Rectum 44, 1043–1048 (2001). https://doi.org/10.1007/BF02235495
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DOI: https://doi.org/10.1007/BF02235495