Background: Pudendal nerve innervation can transform a neo-sphincter into an original anal sphincter-like muscle in animal studies. The results led us to clinical trials of a neo-anus with a pudendal nerve anastomosis (NAPNA). No long-term results in a series have been reported.
Methods: From 1995 to 2003, a neo-anus was reconstructed by using an inferior portion of the gluteus maximum muscle with a pudendal nerve anastomosis contemporaneously with an abdominoperineal excision of the rectum (APER) in 19 patients (17 men, 2 women; median age, 62.0 years; range, 46-73) with low-lying malignancy. The long-term (<2 years) clinical results were evaluated.
Results: The neo-sphincter began contracting (n = 15) at 6.6 +/- 1.8 months after surgery; then the ileostomy was closed (n = 14) at 9.1 +/- 2.6 months. The long-term results were studied in 10 patients (40.9 +/- 14.1 months after ileostomy closure). All patients (100%) defecated at 4.8 +/- 2.6 times/day without irrigation. Pads were used every day in 9 patients (90%). The Cleveland Clinic Florida incontinence score was 12.2 +/- 3.3 points. No patients lost their occupation. Eight patients (80%) answered that their life with a NAPNA was better than with an ileostomy. The average World Health Organization Quality of Life-BREF in patients with NAPNAs was significantly better than that in those patients who underwent conventional APERs in our hospital (n = 27, 66.4 +/- 0.8 years old) ( P = .0402). Four patients (40%) experiencing the need to defecate got significantly better continence score (mean +/- SD).
Conclusions: The sensitivity to recognize the need to defecate may be a key to success in NAPNAs. A NAPNA can be a practical option for selected patients wishing to avoid a stoma after an APER.