CONTINENT PERINEAL COLOSTOMY BY TRANSPOSITION OF GRACILIS MUSCLES - TECHNICAL REMARKS AND RESULTS IN 14 CASES

We herein present a study conducted on 14 patients presenting cancer o f the lower rectum or of the anal canal (10 adenocarcinomas and 4 squa mous-cell carcinomas) and submitted to the Miles abdominal perineal re section in which a new perineal sphincter was constructed. PURPOSE: Th e aim of this study was to evaluate the efficacy of this new perineal sphincter constructed by transposing the gracilis muscles around an or thotopic colostomy in the attempt to avoid a permanent abdominal colos tomy. METHODS: In all cases both gracilis muscles were employed. The r ight one was placed along the posterior wall of the pelvis and fixed t o the controlateral ischiatic tuberosity, creating a sling comparable to the levator ani muscles. The left gracilis was passed around the co lon and attached to the ipsilateral or controlateral tuberosity accord ing to its length, reconstructing a muscular ring. The entire procedur e was performed in one step in nine cases and in more steps in the rem aining five. RESULTS: Of the 14 operated patients, 2 died of vascular disease and 1 developed necrosis of the colonic stump which required r econversion to an abdominal colostomy. Of the remaining 11 patients av ailable for long-term evaluations, 8 showed adequate stool control. Th e remaining three manifested an incomplete level of continence. During the three-year follow-up period, all patients were evaluated by clini cal examination, defecography, endoluminal ultrasonography, nuclear ma gnetic resonance, CT scan, and endoluminal manometry. CONCLUSION: This neosphincter realizes an elastic stenosis responsible for an efficien t level of continence. Best results are observed in the young and educ ated patients submitted to surgery in two steps. Contraindications to this surgery seem to be advanced cancer, old age, and obesity.