Anal sphincter reconstruction by dynamic graciloplasty after abdominoperineal resection for cancer

PURPOSE: Chronic low-frequency electrical stimulation can safely transform fatiguing muscle into fatigue-resistant muscle. This fundamental discovery was used to reconstruct the anal sphincter. Dynamic graciloplasty was found to be effective in the treatment of fecal incontinence. Our study was unde rtaken to investigate the oncologic, functional, and quality of life result s of dynamic graciloplasty anal reconstruction after an abdominoperineal re section for carcinoma. METHODS: Between April 1993 and April 1996, nine pat ients (4 males) with a median age of 51.2 (range, 29-69) years underwent an abdominoperineal resection for carcinoma (4 had a rectal adenocarcinoma an d 5 had an epidermoidal anal tumor) and an anal sphincter reconstruction wi th electrically stimulated graciloplasty. Oncologic and functional results were evaluated after a mean follow-up of 32 (range, 14-50) months. A qualit y of life questionnaire was filled out by seven patients. RESULTS: Sphincte r reconstruction required the same hospitalization period as abdominoperine al resection. Two patients died from evolutive disease. Three patients were operated on twice, one for immediate colonic necrosis, two for colonic per foration after enema. One of them refused the graciloplasty and had an abdo minoperineal resection. Six patients were dysfunctioned. The mean resting p ressure was 24 +/- 10 mmHg, and the mean pressure during stimulation was 95 +/- 25 mmHg. Five patients were continent for solids and liquid; four wore less than three pads per day, and one wore more than three. Four patients used enemas twice a week; one patient had spontaneous evacuation. The quali ty of life questionnaire showed that the mean scores for social interaction , symptoms, and psychological and physical states were 2.1, 2.2, 2.4, and 2 .7, respectively. The mean value was 1.5. CONCLUSIONS: Total anorectal reco nstruction with dynamic graciloplasty is an oncologically safe procedure. F unctional results improve with time, but careful patient selection guarante es a successful functional outcome. Technical progress is necessary to impr ove the quality of life.