ANAL-SPHINCTER RECONSTRUCTION WITH A PUDENDAL NERVE ANASTOMOSIS FOLLOWING ABDOMINOPERINEAL RESECTION - REPORT OF A CASE

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.