Secondary coloperineal pull-through and double dynamic graciloplasty after Miles resection--feasible, but with a high morbidity.

Abstract

Until recently, patients who underwent abdominoperineal resections had to cope with a colostomy for the rest of their lives. For some of these patients this colostomy was a terrible burden, physically and mentally. Publications about abdominoperineal pull-through and double dynamic graciloplasty immediately after a Miles resection showed good results. The purpose of this study was to investigate the procedure as a secondary approach after abdominoperineal resections. In this study seven patients were evaluated. All had had an abdominoperineal resection and proved to have unbearable problems with their stoma. All had a secondary pull-through and double dynamic graciloplasty, a mean of 8.5 (range, 1.1-34.8) years after the Miles resection. In five patients continence was regained; two were reversed to colostomy because of several complications. Patients who had a successful outcome also suffered from numerous complications, with a total mean hospital stay of 73.8 (range, 27-167) days, a mean of 3.1 (range, 1-6) additional operations, and 1.8 (range, 0-4) readmissions. Secondary anorectal reconstruction after abdominoperineal resection is a feasible option, but with a high morbidity. Because of this the procedure was stopped at the beginning of 1997.