LAPAROSCOPICALLY ASSISTED ABDOMINOPERINEAL RESECTION AND SIMULTANEOUSTOTAL ANORECTAL RECONSTRUCTION WITH ELECTROSTIMULATED STATIC-DYNAMIC GRACILOPLASTY

Bilateral electrostimulated graciloplasty, performed in a ''static-dyn amic'' configuration around a perineal colostomy (total anorectal reco nstruction-TAR), has been proven a reliable way to restore continence in patients who undergo to abdomino perineal resection (A.Pe.R.) of th e anorectum for lower rectal cancer. In selected cases, laparoscopical ly assisted TAR can significantly improve body-image preservation and aesthetic results. A 33-year-old woman affected by lower rectal cancer was submitted to laparoscopic-assisted A.Pe.R and TAR with simultaneo us bilateral graciloplasty; a suprapubic median mini-access was adopte d to fully mobilize the mesorectum in absence of pneumoperitoneum. A s ubcutaneous pulse generator and special electrodes were also implanted to chronically electrostimulate the graciloplasty. In spite of postop erative bleeding which required a blood transfusion, postoperative out come was satisfactory; electrostimulation was started on the 10th post operative (p.o.) day and the patient was discharged on the 17th p.o. d ay. Two months after TAR, level II continence (N.S. Williams Scale) wa s achieved. In selected cases, laparoscopically assisted A.Pe.R. and T AR can be safely adopted to preserve body image and quality of life, a voiding at the same time a large abdominal approach and a ''permanent' ' abdominal colostomy.