Cancer Therapy

Biography

Biography: Abhijit Chandra

Abstract

Background: Perineal transposition of antropyloric valve (APV), based on left gastroepiploic pedicle has been used for total anorectal reconstruction in patients suffering from end-stage fecal incontinence. We studied patients who underwent successful perineal APV transposition for end stage fecal incontinence, either after irreparable anal sphincter trauma, anorectal malformation (ARM) or following abdomino-perineal resection (APR). Patients: Twenty patients underwent the procedure. Nine patients had replacement (following APR) (group 1) and 11 patients had augmentation (for severe anal sphincter injury or ARM) (group 2) of the anal sphincter. Two patients in group 1 with early graft-related complications were excluded from further analysis, because they had the grafts excised. Main Outcome Measures: The primary outcome measures were anatomical integrity and functional status of the graft in the perineum, fecal incontinence scores, and quality-of-life scores (SF-36) over a median follow-up of 24 months. Results: The transposed grafts had a definite tone on digital examination, were well visualized on perineal MRI, showed high-velocity vascular inflow on Doppler ultrasound study and good vascularity on CT angiography. Anal manometry showed a significant (p=0.03) rise in the post-operative resting neo-sphincter pressures with good retention of barium proximal to pyloric valve on distal loopogram. The postoperative St Mark incontinence score improved in both groups and was significantly better in group 2 than in group 1. There was significant improvement in postoperative physical and mental component scores in both groups. Conclusions: APV can be used successfully for a selected group of patients with end-stage fecal incontinence. Patients undergoing anal sphincter augmentation (for severe anal sphincter injury or ARM) have better outcomes in comparison with those having an excised sensate anorectum (after APR).