Since 1995, we have performed “neo-anus surgery”.
Introduction of
‘neoanus with a pudendal nerve anastomosis’ (NAPNA)
after abdominoperineal excision of the rectum
Chapter 4
Life without a stoma
Neo-anus reconstruction allows the new anal sphincter to start functioning in about six months after surgery. After confirmation of this functioning, the stoma is closed and the patient begins to use the neo-anus. In other words, all of the patients undergoing this operation can experience life with a stoma temporarily and compare it to the neo-anus life by themselves. It should be the strictest evaluation of this operation.
There have been 22 patients undergoing this operation until March 3, 2003. In 22 patients, 15 have started using the neo-anus. In addition, three patients soon after the operation are waiting to use the neo-anus.
Unfortunately, two of 22 had to give up using neo-anus and use the stoma forever due to the postoperative complications derived from the infection at the sutured skin and necrosis of the large intestine that was mobilized to the perineum. Another two had cancer recurrences soon after the operation, and had to abandon the hope to use neo-anus for treatment. Anyway, 15 patients escaped from colostomy and experienced a new life with neo-anus until now. The postoperative life was evaluated in 10 patients leading a more than two-year life with neo-anus out of 15.
In terms of satisfaction, eight patients (80%) evaluated a life with neo-anus as better than that with a stoma, while two (20%) responded as neither good nor bad. No one preferred a life with a stoma nor wanted to go back to it. (One of the advantages of this operation is that you can return to a life with a stoma. Needless to say, another operation is required.)
However, despite the high levels of satisfaction, defecation status is not necessarily scored as a full mark or 100%. In any case, the clinical outcome is not so wonderful compared with the complete anal function at the age of 20, 30, 40 or so. If you think that you may be fine with the anus of old people that occasionally smears the underwear, the operation may be markedly beneficial. Everyone wishes to have anus as close as possible to the one that the god created, but the point of contention is which is better, a stoma or neo-anus. The current status of the neo-anus revealed that as much as 80% supported the superiority of the neo-anus and 20% remains undecided. We thought that it was important for the patient about to have a stoma and those who wanted to be free from colostomy to know what the operation was like.
The X-ray below, called defecography, is a picture demonstrating the defecation status after contrast medium as solid as feces is put into the anorectal area. Because it is animation, it would be easy to understand the defecation status.
Animation comprises five pieces of X-ray: the first one, at relaxed state; the second one, at the time of continence; and from the third to fifth, during the defecation. When patients are holding, the anal canal is elongated, and at the time of defecation, the sphincter relaxes and the movement of feces can be seen.
Index .
Preface To avoid colostomy or stoma, there is a neoanus surgery.
Chapter 1. Comments on rectal cancer for neoanus surgery
Chapter 2. A path to develop a new operation to avoid colostomy (neoanus
surgery)
Chapter 3. Outlines of the operation avoiding colostomy
Chapter 4. Life without a stoma
Chapter 5 Miscellaneous with self-introduction
Chapter 6 Bibliography
Link
Correspondence to:
Tomoyuki Sato M.D., Ph.D. Assistant Professor, Center for Clinical Medicine
and Research, International University of Health and Welfare
Iguchi, Nishinasuno-machi, Nasu-gun, Tochigi-ken, Japan
Email address: tomosato@iuhw.ac.jp
Fax: to Dr. Sato +81-287-39-3001
or
Tomoyuki Sato M.D., Ph.D. Department of Surgery, Jichi Medical School
3311-1 Yakushiji, Minamikawachi-machi, Kawachi-gun, Tochigi-ken, 329-0498,
Japan
Email address: tomoyuki@jichi,ac.jp
fax: +81-285-44-3234
Link to the Japanese website of the stomaless surgery (Neo-anus)