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.
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.
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).
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
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Comparison of quality of life in patients undergoing abdominoperineal extirpation of anterior resection for rectal cancer.Ann Surg. 2001; 233: 145-156
- Quality of life in rectal cancer patients: a four-year prospective study.Ann Surg. 2003; 238: 203-213
- Quality of life in stoma patients.Dis Colon Rectum. 1999; 42: 1569-1574
- 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: 82-190
- The electrically stimulated gracilis neosphincter incorporated as part of total anorectal reconstruction after abdominoperineal excision of the rectum.Ann Surg. 1996; 224: 702-711
- Total anorectal reconstruction with a double dynamic graciloplasty after abdominoperineal reconstruction for low rectal cancer.Dis Colon Rectum. 1997; 40: 698-705
- Long-term efficacy of dynamic graciloplasty for fecal incontinence.Dis Colon Rectum. 2002; 45: 809-818
- Development of an electrically stimulated neoanal sphincter.Lancet. 1991; 338: 1166-1169
- Dynamic graciloplasty for treatment of faecal incontinence.Lancet. 1991; 338: 1163-1165
- Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial.Gastroenterology. 1999; 116: 549-556
- Secondary coloperineal pull-through and double dynamic graciloplasty after Miles resection—feasible, but with a high morbidity.Dis Colon Rectum. 1999; 42 (discussion 781): 776-780
- Total anorectal reconstruction—fact or fiction.Swiss Surg. 1997; 3: 262-265
- Electromyography of the sphincter ani externus in man.J Physiol. 1953; 122: 599-609
- Electromyography of the sphincter muscles: contemporary.Clin Neurophysiology. 1978; : 405-416
- Physiology and pathophysiology of the anal canal.Int Surg. 1982; 67: 291-298
- Functional perineal colostomy with pudendal nerve anastomosis following anorectal resection: an experimental study.Surgery. 1996; 119: 641-651
- Functional perineal colostomy with pudendal nerve anastomosis following anorectal resection: a cadaver operation study on a new procedure.Surgery. 1997; 121: 569-574
- Anal sphincter reconstruction with a pudendal nerve anastomosis following abdominoperineal resection: report of a case.Dis Colon Rectum. 1997; 40 (discussion 1502-3): 1497-1502
- Physiological anorectal reconstruction with pudendal nerve anastomosis and a colonic S-pouch after abdominoperineal resection: report of 2 successful cases.Surgery. 2000; 128: 116-120
- Colonic “coloplasty”: novel technique to enhance low colorectal or coloanal anastomosis.Dis Colon Rectum. 2000; 43: 1448-1450
- Prospective, randomized, controlled trial of proximally based vs. distally based gluteus maximus flap for anal incontinence in. cadavers.Dis Colon Rectum. 2002; 45: 1100-1103
- Pudendal nerve “complete”motor latencies at four different levels in the anal sphincter system in young adults.Dis Colon Rectum. 2002; 45: 923-927
- Optimization of sphincter function after the ileoanal reservoir procedure. A prospective, randomized trial.Dis Colon Rectum. 1994; 37: 419-423
- World Health Organization Quality Of Life The WHO quality of life assessment instrument (WHOQOL-BREF): the importance of its items for cross-cultural research.Qual Life Res. 2001; 10: 711-721
- Experimental model of pudendal nerve innervation of a skeletal muscle neosphincter for faecal incontinence.Br J Surg. 1997; 84: 1269-1273
- Total anorectal reconstruction results in complete anorectal sensory loss.Br J Surg. 1996; 83: 57-59
- Artificial bowel sphincter: long-term experience at a single institution.Dis Colon Rectum. 2003; 46: 722-729
Accepted: May 7, 2004Tochigi-ken and Saitama, Japan
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.