Continent perineal colostomy by transposition of gracilis muscles - Technical remarks and results in 14 cases

Emanuele Santoro, C. Tirelli, F. Scutari, A. Garofalo, G. Silecchia, M. Scaccia, Eugenio Santoro

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

We herein present a study conducted on 14 patients presenting cancer of the lower rectum or of the anal canal (10 adenocarcinomas and 4 squamous-cell carcinomas) and submitted to the Miles abdominal perineal resection in which a new perineal sphincter was constructed. PURPOSE: The aim of this study was to evaluate the efficacy of this new perineal sphincter constructed by transposing the gracilis muscles around an orthotopic colostomy in the attempt to avoid a permanent abdominal colostomy. METHODS: In all cases both gracilis muscles were employed. The right one was placed along the posterior wall of the pelvis and fixed to the controlateral ischiatic tuberosity, creating a sling comparable to the levator ani muscles. The left gracilis was passed around the colon and attached to the ipsilateral or controlateral tuberosity according to its length, reconstructing a muscular ring. The entire procedure was performed in one step in nine cases and in more steps in the remaining five. RESULTS: Of the 14 operated patients, 2 died of vascular disease and 1 developed necrosis of the colonic stump which required reconversion to an abdominal colostomy. Of the remaining 11 patients available for long-term evaluations, 8 showed adequate stool control. The remaining three manifested an incomplete level of continence. During the three-year follow-up period, all patients were evaluated by clinical examination, defecography, endoluminal ultrasonography, nuclear magnetic resonance, CT scan, and endoluminal manometry. CONCLUSION: This neosphincter realizes an elastic stenosis responsible for an efficient level of continence. Best results are observed in the young and educated patients submitted to surgery in two steps. Contraindications to this surgery seem to be advanced cancer, old age, and obesity.

Original languageEnglish
JournalDiseases of the Colon and Rectum
Volume37
Issue number2 Supplement
DOIs
Publication statusPublished - Feb 1994

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Colostomy
Anal Canal
Defecography
Manometry
Rectal Neoplasms
Pelvis
Vascular Diseases
Squamous Cell Carcinoma
Ultrasonography
Pathologic Constriction
Colon
Adenocarcinoma
Necrosis
Magnetic Resonance Spectroscopy
Obesity
Gracilis Muscle
Muscles
Neoplasms

Keywords

  • Abdominoperineal resection
  • Colostomy
  • Gracilis muscles
  • Neoanal sphincter

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Continent perineal colostomy by transposition of gracilis muscles - Technical remarks and results in 14 cases. / Santoro, Emanuele; Tirelli, C.; Scutari, F.; Garofalo, A.; Silecchia, G.; Scaccia, M.; Santoro, Eugenio.

In: Diseases of the Colon and Rectum, Vol. 37, No. 2 Supplement, 02.1994.

Research output: Contribution to journalArticle

Santoro, Emanuele ; Tirelli, C. ; Scutari, F. ; Garofalo, A. ; Silecchia, G. ; Scaccia, M. ; Santoro, Eugenio. / Continent perineal colostomy by transposition of gracilis muscles - Technical remarks and results in 14 cases. In: Diseases of the Colon and Rectum. 1994 ; Vol. 37, No. 2 Supplement.
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