T. Sato et al., FUNCTIONAL PERINEAL COLOSTOMY WITH PUDENDAL NERVE ANASTOMOSIS FOLLOWING ANORECTAL RESECTION - A CADAVER OPERATION STUDY ON A NEW PROCEDURE, Surgery, 121(5), 1997, pp. 569-574
Background. We have previously studied functional perineal colostomy t
hat used skeletal muscle with pudendal nerve anastomosis (PNA) followi
ng anorectal resection in an animal model. In that study the neosphinc
ter reconstructed with PNA achieved the proper functions of the extern
al anal sphincter resulting in a satisfactory defecatory condition. Th
is study was a preliminary step before applying this procedure to huma
n beings. Methods, We reconstructed a new anal sphincter by using the
lower part of the gluteus maximus muscle (lower GMM) with PNA in a tot
al of six sides of four human cadavers and investigated the anatomic p
roblems associated with this procedure. Results, We classified the bra
nching patterns of the inferior gluteal nerve into three types. The le
ngth of the branches of the inferior gluteal nerve to the lower GMM va
ried from 32 to 76 mm (median, 57 mm). The length of the pudendal nerv
e (PN) passing out below the sacrotuberous ligament varied from 21 to
44 mm (median, 29.5 mm). The PN was anastomosed to the nerve innervati
ng the lower GMM with the redundancy of 17 to 36 mm (median, 24.5 mm).
In all cases the anal sphincter reconstruction with a PNA maneuver wa
s anatomically feasible by using the lower GMM. The length of the new
anal canal was 65 to 80 mm (median, 67.5 mm). Conclusions. The PNA man
euver was an anatomically applicable method to make a neoanus in human
beings. Preparation for the application of this method to human being
s was accomplished.