Background
Pudendal nerve innervation can transform a neo-sphincter into an original anal sphincter–like
muscle in animal studies. The results led us to clinical trials of a neo-anus with
a pudendal nerve anastomosis (NAPNA). No long-term results in a series have been reported.
Methods
From 1995 to 2003, a neo-anus was reconstructed by using an inferior portion of the
gluteus maximum muscle with a pudendal nerve anastomosis contemporaneously with an
abdominoperineal excision of the rectum (APER) in 19 patients (17 men, 2 women; median
age, 62.0 years; range, 46-73) with low-lying malignancy. The long-term (<2 years)
clinical results were evaluated.
Results
The neo-sphincter began contracting (n = 15) at 6.6 ± 1.8 months after surgery; then the ileostomy was closed (n = 14) at 9.1 ± 2.6 months. The long-term results were studied in 10 patients (40.9 ±
14.1 months after ileostomy closure). All patients (100%) defecated at 4.8 ± 2.6 times/day
without irrigation. Pads were used every day in 9 patients (90%). The Cleveland Clinic
Florida incontinence score was 12.2 ± 3.3 points. No patients lost their occupation.
Eight patients (80%) answered that their life with a NAPNA was better than with an
ileostomy. The average World Health Organization Quality of Life-BREF in patients
with NAPNAs was significantly better than that in those patients who underwent conventional
APERs in our hospital (n = 27, 66.4 ± 0.8 years old) (P = .0402). Four patients (40%) experiencing the need to defecate got significantly better
continence score (mean ± SD).
Conclusions
The sensitivity to recognize the need to defecate may be a key to success in NAPNAs.
A NAPNA can be a practical option for selected patients wishing to avoid a stoma after
an APER
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Article info
Publication history
Accepted:
May 7,
2004
Tochigi-ken and Saitama, JapanIdentification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
