Total anorectal reconstruction: a novel technique

Devesa, J. M.; López-Hervás, P; Vicente, Rosana; Rey, Antonio; Die, J.; Fraile, A.

doi:10.1007/s10151-005-0215-4

Cited by 13 publications

(4 citation statements)

References 6 publications

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“…To address these issues, gracilis [5] and gluteus maximus muscle transfer [6] and artificial sphincter implantation [7] have been reported for restoring anal function. However, none of these is a gold standard technique because anal functions are very complicated [8]. Meanwhile, owing to improvements in surgical instruments and immunosuppressive therapy, organ transplantation has gained great popularity worldwide.…”

Section: Introductionmentioning

confidence: 99%

The Development of a Canine Anorectal Autotransplantation Model Based on Blood Supply: A Preliminary Case Report

Araki

Nakamura

Sato³

et al. 2012

PLoS ONE

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Colostomy is conventionally the only treatment for anal dysfunction. Recently, a few trials of anorectal transplantation in animals have been published; however, further development of this technique is required. Moreover, it is crucial to perform this research in dogs, which resemble humans in anorectal anatomy and biology. We designed a canine anorectal transplantation model, wherein anorectal autotransplantation was performed by anastomoses of the rectum, inferior mesenteric artery (IMA) and vein, and pudendal nerves. Resting pressure in the anal canal and anal canal pressure fluctuation were measured before and after surgery. Graft pathology was examined three days after surgery. The anal blood supply was compared with that in three beagles using indocyanine green (ICG) fluorescence angiography. The anorectal graft had sufficient arterial blood supply from the IMA; however, the graft’s distal end was congested and necrotized. Functional examination demonstrated reduced resting pressure and the appearance of an irregular anal canal pressure wave after surgery. ICG angiography showed that the pudendal arteries provided more blood flow than the IMA to the anal segment. This is the first canine model of preliminary anorectal autotransplantation, and it demonstrates the possibility of establishing a transplantation model in dogs using appropriate vascular anastomoses, thus contributing to the progress of anorectal transplantation.

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Section: Introductionmentioning

confidence: 99%

The Development of a Canine Anorectal Autotransplantation Model Based on Blood Supply: A Preliminary Case Report

Araki

Nakamura

Sato³

et al. 2012

PLoS ONE

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“…To address these issues, some reconstructive methods including gracilis6 or gluteus maximus muscle transfer7, antropylorus transposition8, and artificial sphincter implantation9 have been reported to restore anal function. However, none of these are a ‘gold standard’ technique due to the complex nature of anal functions10. Meanwhile, owing to improvements in microsurgical technique, instruments, and immunosuppressive therapy, organ transplantation has gained great popularity worldwide.…”

mentioning

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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“…Both of these complex techniques were not, however, associated with particularly good function. A simpler approach is to translate a 6–7 cm long coloplasty above a colo-anal anastomosis, as advocated by Fazio and colleagues [66], or by Devesa, who performed a longitudinal colonic myotomy proximal to a neosphincter, designed to diminish the peristaltic activity of the descending colonic segment [67]. …”

Section: Total Anorectal Reconstructionmentioning

confidence: 99%

“…The initially good results seen in his eight cases prompted similar work by Devesa et al in a small number of cases, but the high rate of complications and the need for explants (as in those patients treated primarily for AI) did not result in extensive use of this technique [67]. The use of an anal sling as a supplement to TAR (a subject covered elsewhere for the management of AI in this special edition) has not been reported.…”

Section: Total Anorectal Reconstructionmentioning

confidence: 99%

The antegrade continence enema procedure and total anorectal reconstruction

Zbar

2014

Gastroenterology Report

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Patients may present with anal incontinence (AI) following repair of a congenital anorectal anomaly years previously, or require total anorectal reconstruction (TAR) following radical rectal extirpation, most commonly for rectal cancer. Others may require removal of their colostomy following sphincter excision for Fournier's gangrene, or in cases of severe perineal trauma. Most of the data pertaining to antegrade continence enema (the ACE or Malone procedure) comes from the pediatric literature in the management of children with AI, but also with supervening chronic constipation, where the quality of life and compliance with this technique appears superior to retrograde colonic washouts. Total anorectal reconstruction requires an anatomical or physical supplement to the performance of a perineal colostomy, which may include an extrinsic muscle interposition (which may or may not be ‘dynamized'), construction of a neorectal reservoir, implantation of an incremental artificial bowel sphincter or creation of a terminal, smooth-muscle neosphincter. The advantages and disadvantages of these techniques and their outcome are presented here.

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Total anorectal reconstruction: a novel technique

Cited by 13 publications

References 6 publications

The Development of a Canine Anorectal Autotransplantation Model Based on Blood Supply: A Preliminary Case Report

The Development of a Canine Anorectal Autotransplantation Model Based on Blood Supply: A Preliminary Case Report

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

The antegrade continence enema procedure and total anorectal reconstruction

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