Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Araki, Jun; Sato, Tomoyuki; Naito, Makoto; Akita, Keiichi; Tashiro, Kensuke; Iida, Takuya; Koshima, Isao

doi:10.1371/journal.pone.0068977

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…Next, the functional recovery of the transplanted anorectal graft and long-term follow-up studies are required after the anorectal allotransplantation. In parallel, experimental human cadaver study needs to go on 25 .…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Anorectal transplantations (ATx) have been described experimentally in rat 8 9 10 11 , pig 12 13 , dog 14 15 , and human cadaver 16 models. Most of these studies evaluated the technical aspects of autologous transplantation, whereas others covered complex and hardly reproducible surgical techniques.…”

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confidence: 99%

Allogeneic anorectal transplantation in rats: technical considerations and preliminary results

Galvão

Waisberg

Seid

et al. 2016

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Fecal incontinence is a challenging condition with numerous available treatment modalities. Success rates vary across these modalities, and permanent colostomy is often indicated when they fail. For these cases, a novel potential therapeutic strategy is anorectal transplantation (ATx). We performed four isogeneic (Lewis-to-Lewis) and seven allogeneic (Wistar-to-Lewis) ATx procedures. The anorectum was retrieved with a vascular pedicle containing the aorta in continuity with the inferior mesenteric artery and portal vein in continuity with the inferior mesenteric vein. In the recipient, the native anorectal segment was removed and the graft was transplanted by end-to-side aorta-aorta and porto-cava anastomoses and end-to-end colorectal anastomosis. Recipients were sacrificed at the experimental endpoint on postoperative day 30. Surviving animals resumed normal body weight gain and clinical performance within 5 days of surgery. Isografts and 42.9% of allografts achieved normal clinical evolution up to the experimental endpoint. In 57.1% of allografts, signs of immunological rejection (abdominal distention, diarrhea, and anal mucosa inflammation) were observed three weeks after transplantation. Histology revealed moderate to severe rejection in allografts and no signs of rejection in isografts. We describe a feasible model of ATx in rats, which may allow further physiological and immunologic studies.

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“…O transplante anorretal foi desenvolvido experimentalmente por nosso grupo 56,58 e outros 59,62 como potencial tratamento da incontinência fecal grave ou colostomia definitiva. Nesses estudos os autores observaram a viabilidade da técnica cirúrgica e a recuperação funcional precoce desse enxerto após o transplante.…”

Section: Resultados • Transplante De óRgãos Pélvicosunclassified

Transplante de órgãos pélvicos: uma nova proposta de tratamento para incontinência fecal e urinária

Iuamoto¹,

Traldi

Lee

et al. 2015

Rev. Med. (São Paulo)

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Incontinência fecal e urinária é um problema atual de saúde pública, com enorme impacto social e econômico. Tratamentos para esse problema são insuficientes. Após investigação anatômica, percebemos o assoalho pélvico como tecido composto independente que compartilha pedículo vascular (ilíaca interna) e neuronal (pudendo) comum. Neste manuscrito nós descrevemos transplante de órgãos pélvicos em ratos e cadáveres. Doador - Uma incisão combinada perineal e abdominal foi realizada. A dissecção progrediu perto do anel pélvico; o nervo pudendo e seus vasos foram divididos permitindo a mobilização total do assoalho pélvico. Através da incisão abdominal, genitália, bexiga e reto foram mobilizados. A aorta e a veia cava foram isoladas, preservando os vasos ilíacos internos e os vasos espermáticos. Os enxertos contendo pele, complexo muscular, ligamentos, bexiga, uretra, vagina ou pênis, reto, ânus, útero, ovário, testículo e seus condutos foram removidos. Receptor - A mesma estratégia de incisão e dissecção do doador foi realizada. Os vasos ilíacos internos, incluindo vasos retais e nervos pudendo foram divididos e os tecidos do assoalho pélvico foram removidos em bloco. A aorta e a veia cava infra-renal foram isolados, o enxerto foi colocado no abdômen e foi realizada anastomose aorta-aorta e cava-cava. Também realizamos anastomoses do ureter, reto e nervos e vasos pudendo. O assoalho pélvico foi colocado em sua posição original por pontos entre os ligamentos do assoalho pélvico, nervos e vasos pudendo, peritônio e da pele, concluindo a operação. Nesta pesquisa, mostramos que a cirurgia de transplante do assoalho pélvico é viável.

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Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Cited by 9 publications

References 30 publications

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

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

Allogeneic anorectal transplantation in rats: technical considerations and preliminary results

Transplante de órgãos pélvicos: uma nova proposta de tratamento para incontinência fecal e urinária

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