Total anorectal and partial vaginal reconstruction with dynamic graciloplasty and colonic vaginoplasty after extended abdominoperineal resection - Report of a case

PURPOSE: Quality of life is altered after abdominoperineal resection, becau se of permanent iliac colostomy. Psychological rehabilitation is even more difficult after extended abdominoperineal resection to the vagina, because of the loss of both continence and sexual functions. We report the first ca se of total anorectal and vaginal reconstruction using dynamic graciloplast y and colonic vaginoplasty after extended abdominoperineal resection. METHO DS: A 46-year-old female underwent extended abdominoperineal resection with posterior colpectomy for a low rectal adenocarcinoma infiltrating the anal sphincter and vagina. Anorectal reconstruction was performed with coloperi neal anastomosis and double dynamic graciloplasty. Vaginal reconstruction w as performed using a 10-cm, isolated, rotated sigmoid loop. The procedure w as performed in three stages, including abdominoperineal resection with rec onstruction, implantation of the stimulator, and closure of the temporary i leostomy. RESULTS: Resting and electrostimulated pressures of the neosphinc ter were 40 and 110 cm H2O respectively. Continence was achieved for formed stools two months after closure of the stoma, with spontaneous defecations (30-90 minutes). The patient experienced regular sexual activity six month s after closure of the stoma. CONCLUSION: This new original technique can b e proposed in selected young females after extended abdominoperineal resect ion, to preserve continence, sexual activity, and body image.