T. Sato et al., ANAL-SPHINCTER RECONSTRUCTION WITH A PUDENDAL NERVE ANASTOMOSIS FOLLOWING ABDOMINOPERINEAL RESECTION - REPORT OF A CASE, Diseases of the colon & rectum, 40(12), 1997, pp. 1497-1501
PURPOSE AND METHODS: We report herein a case of a patient with rectal
carcinoma in whom a new anus was constructed following an abdominoperi
neal resection of the anorectum. This is the first reported case in wh
ich reconstruction of the anal sphincter was performed using the lower
part of the gluteus maximus muscle with a pudendal nerve anastomosis.
The pudendal nerve anastomosis maneuver was designed to achieve prope
r innervation and function of the external anal sphincter. This newly
reconstructed sphincter was physiologically evaluated after surgery. R
ESULTS: The patient's defunctioning colostomy was not closed following
his initial surgery because part of the transposed muscle was devital
ized by infection following blood flow damage, However, purposeful con
traction of the new sphincter was easy to achieve without special trai
ning. The patient's rectal sensation for the desire to defecate was sa
tisfactory. Electromyographic studies demonstrated that the newly reco
nstructed anal sphincter had characteristics of the original external
anal sphincter, CONCLUSIONS: This method is a promising procedure for
reconstricting the anal sphincter.