Double dynamic graciloplasty and coloperineal pull-through after abdominoperineal resection.

Abstract

In patients with a very low rectal carcinoma, an abdominoperineal resection with the creation of a permanent colostomy is the surgical treatment of choice. Creation of a colostomy can be avoided without compromise to oncological safety. The distal colon is pulled through to the perineum and both gracilis muscles are used to create a new sphincter and pelvic floor. These muscles are electrically stimulated by an implanted neurostimulator. Contraction is then no longer dependent upon volition and, due to fibre transformation, the muscle will become fatigue-resistant. The outcome in 11 patients was assessed. After a mean follow-up of 1.3 years, continence was achieved in 7 patients, and 2 patients are awaiting completion of the therapy. In 2 patients, necrosis of the distal colon led to failure of the technique. There was no local recurrence, but 2 patients had distant metastasis. Double dynamic graciloplasty after abdominoperineal resection proves to be an oncologically safe procedure with a reasonable chance of continence and a life without a stoma in the majority of patients.