Restoration of gastrointestinal continuity and continence after abdominoperineal excision of the rectum using an electrically stimulated neoanal sphincter

Abstract

A new operation is described in which a neorectum and neoanal sphincter mechanism have been constructed to restore gastrointestinal continuity and continence in a patient who required abdominoperineal excision of the rectum for a low rectal cancer. The neorectum was constructed by bringing colon down into the pelvis and anastomosing it to the perineal skin. The neoanal sphincter was fashioned from a transposed gracilis muscle and was activated electrically by a totally implanted stimulator. A period of chronic low-frequency stimulation altered the muscle characteristics and enabled the neosphincter to contract continually without fatigue. The patient was continent when the stimulator was turned on and was able to void when the stimulator was turned off.