Anorectal transplantation

Galvão, Flávio Henrique Ferreira; Seid, Víctor Edmond; Kitamura, Michihiko; Galvão, Raoni de Castro; Pinto, Rodrigo Ambar; Santos, Rafael Miyashiro Nunes dos

doi:10.1007/s10151-009-0459-5

Cited by 19 publications

(21 citation statements)

References 14 publications

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“…In that study, the anorectum from female pigs was transplanted into male pigs without immunosuppression and successful inferior mesenteric artery (IMA), inferior mesenteric vein (IMV), and pudendal nerve (PN) anastomoses were achieved. Since then, similar experimental studies have been reported using rat [8–10], swine [11], and canine models [12]. However, no reports currently exist in the literature examining the possibility of anorectal transplantation in humans.…”

Section: Introductionmentioning

confidence: 83%

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Araki

Sato²,

Naito

et al. 2013

PLoS ONE

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BackgroundAnorectal transplantation is a method for patients who have lost their anorectal function or suffer from congenital anorectal dysfunction to recover this function, and this has been investigated in experimental animal models using pigs, dogs, and rats. In this study, we performed an examination of anorectal transplantation in human cadavers to investigate whether this procedure could be performed in patients.MethodsA 77-year-old woman cadaver 1 was used as the donor and a 98-year-old woman cadaver 2 was used as the recipient. Initially, abdominoperineal excision of the anus and rectum (the Miles’ operation) was performed on the recipient. Next, an anorectal graft containing the pudendal nerve (PN), pudendal artery (PA), pudendal vein (PV), inferior mesenteric artery (IMA), and inferior mesenteric vein (IMV) was harvested from the donor. The donor graft was transplanted into the recipient by intestinal anastomosis and microneurovascular anastomoses orthotopically.ResultsThe diameters of the PN (right/left), IMA, and IMV were 2.5 mm/2.5 mm, 2.0 mm, and 1.5 mm, respectively, in cadaver 1, and 2.0 mm/2.0 mm, 2.0 mm, and 2.0 mm, respectively, in cadaver 2. The length of the PN, PA, PV, IMA, and IMV in the graft was sufficient to allow proper anastomosis.ConclusionThis preliminary study indicated that human anorectal transplantation was possible anatomically and technically. We anticipate our study will aid in the potential future application of this procedure to human patients.

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Section: Introductionmentioning

confidence: 83%

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Araki

Sato²,

Naito

et al. 2013

PLoS ONE

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“…Histological examination revealed satisfactory inferior mesenteric flow at 24 h after surgery; however, more detailed information regarding this is unavailable. Recently, Galvão et al reported the development of a rat intestinal transplantation model (including the small and large bowel, rectum, and anus) by anastomoses of the recipient's aorta to the donor's aorta, and the donor's portal vein to the recipient's superior mesenteric vein16. Further, they succeeded in swine anorectal autotransplantation by anastomoses between the IMA and the aorta, the IMV and vena cava, and the PNs.…”

Section: Discussionmentioning

confidence: 99%

“…of all organs involved in defecation, including the perineal skin, anus, rectum, and the sphincter muscle) has strong potential as an innovative therapy for anal dysfunction. Anorectal transplantation models using rats1617 and swine1819 have been reported in experimental trials; however, these experimental systems have considerable drawbacks. Because rats and pigs do not have the capacity to inhibit defecation and habits similar to those of humans, they are not particularly useful as model subjects for human application.…”

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confidence: 99%

Anorectal autotransplantation in a canine model: the first successful report in the short term with the non-laparotomy approach

Araki

Nakamura

Sato³

et al. 2014

Sci Rep

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Colostomy is conventional treatment for anal dysfunction. Recently, a few trials of anorectal transplantation in animals have been published as a potential alternative to colostomies; however, further development of this technique is required. In this study, we utilized a canine model of anorectal transplantation, evaluated the patency of our microsurgical anastomoses, and assessed the perfusion of the transplanted anus. We designed a canine anorectal transplantation model, wherein anorectal autotransplantation was performed in four healthy beagle dogs by anastomoses of the lower rectum, the bilateral pudendal arteries (PAs) and veins (PVs), and pudendal nerves (PNs). Postoperative graft perfusion was measured by indocyanine green (ICG) angiography and histological examination. The length of the anorectal graft including perianal skin, anal sphincter muscle, bilateral PAs, PVs, and PNs was 4.9 ± 0.3 cm. All diameters of the PAs, PVs, and PNs were large enough to be microscopically anastomosed. Both ICG angiography and histological examination demonstrated good graft perfusion, except for one case that lead to venous congestion. These results show that anastomosis of the bilateral PAs, PVs, and PNs is required for anorectal transplantation. This is the first successful report of canine anorectal autotransplantation.

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“…Este modelo experimental estimulou o desenvolvimento de outros modelos que contemplassem o estudo do transplante do intestino grosso em seu segmento distal, incluindo o esfíncter anal. Isso culminou na descrição de um modelo inédito de transplante autólogo anorretal em ratos, que se mostrou muito interessante para o estudo da função deste segmento, e permitiu avaliação sem a interferência da rejeição do enxerto 90 . Nesse trabalho eles comparam um modelo de transplante anorretal ortotópico, onde o ânus era posicionado em sua localização original e o heterotópico, onde o ânus era exteriorizado na parede abdominal como uma anustomia, com a ressecção do segmento anorretal e colostomia.…”

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“…Nos grupos de auto-transplante foram observados restauração da de defecação e ganho de peso logo na primeira semana de pós-operatório. Ao contrário, no grupo que sofreu colostomia, os animais mostraram complicações e altos índices de mortalidade 90 . Em modelo mais recente, animais submetidos a transplante isogênico mostraram evolução clínica semelhante às observadas nos grupos de auto-transplante 91 .…”

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Transplante anorretal como proposta terapêutica para o tratamento de incontinência fecal e colostomia definitiva

Hirano

Seid

Galvão

et al. 2013

Rev. Med. (São Paulo)

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RESUMO:A incontinência fecal é um problema de enorme impacto social e econômico. Com semelhante semblante encontrase a colostomia definitiva, outra situação de igual gravidade e impacto sobre a vida dos pacientes. Neste trabalho, reuniram-se artigos retirados das bases de dados Cochrane Library, Medline e Embase para tratar das atuais situações desses problemas. A abordagem é realizada através dos tópicos Prevalência e impacto, Etiologia e Tratamento, sendo nesse último descrito e comentado o procedimento do transplante anorretal. A análise realizada revela a atual situação ruim para o tratamento da incontinência fecal e colostomia definitiva, mas coloca o transplante anorretal como proposta futura capaz de alterar essa realidade. DESCRITORES:Transplante heterotópico; Transplante autólogo; Transplante isogênico; Incontinência fecal; Colostomia.ABSTRACT: Fecal incontinence is a problem of great social and economic impact. With similar aspects, there is the definitive colostomy, another situation of equal gravity and impact over the patient's lives. In this work, articles from Cochrane Library, Medline and Embase were revised using these problems as parameters. The approach is systematically accomplished through the topics Prevalence and impact, Etiology and Treatment, with the description of anorectal transplantation in this last topic. The analysis reveals the bad situation of treatment for fecal incontinence and definitive colostomy nowadays, but settles the anorectal transplantation as a future proposal capable of changing this reality. KEYWORDS:

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Anorectal transplantation

Abstract: Autotransplantation in the rat is a simple technique, achieves a high rate of success and better clinical evolution than colostomy. This model may ultimately lead to research into anorectal transplantation.

Cited by 19 publications

References 14 publications

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Anorectal autotransplantation in a canine model: the first successful report in the short term with the non-laparotomy approach

Transplante anorretal como proposta terapêutica para o tratamento de incontinência fecal e colostomia definitiva

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