Perirectal graciloplasty: a novel surgical technique for the treatment of the neurogenic rectum and rectal inertia.

Abstract

A novel technique for evacuation of the denervated rectum was carried out on 11 mongrel dogs (mean weight 15.8 +/- 4.6 kg). The gracilis muscle was mobilized from the thigh, pedicled on its origin from the pubic ramus, and was introduced into the ischiorectal fossa through a para-anal incision. The abdomen was opened and the rectum mobilized and wrapped with the gracilis muscle which was pulled through the ischiorectal fossa into the pelvis. Rectal denervation was induced by bilateral pelvic ganglionectomy; cystostomy was performed owing to the resultant vesical denervation. Two electrodes were sutured to the gracilis muscle and connected to a myostimulator. The effect of electrostimulation of the gracilis muscle on the rectal and rectal neck (anal canal) pressures and on balloon expulsion was determined. Gracilis muscle stimulation with a burst of 30 Hz during 300 msec with a stimulus of 0.5 msec and an intensity just suprathreshold effected a rectal pressure rise (P < 0.001) with no rectal neck pressure change (P > 0.05); balloon expulsion occurred at a mean balloon filling of 14.8 +/- 3.2 mL. Gracilis muscle transposition could be a suitable experimental model for evacuation of the neurogenic rectum. The technique might be considered for the treatment of the neurogenic rectum, or rectal inertia.