Use of the gluteus maximus muscle as the neosphincter for restoration of anal function after abdominoperineal resection

Total anorectal reconstruction (TAR) consists of a series of procedures that have been described
for the reconstruction of the rectum and the sphincter mechanism in patients who have lost them
either due to abdominoperineal resection, traumatic injuries or congenital malformations.
Removal of the rectum and anus leads to the loss of an adaptable reservoir that has the ability to
distend, store and discharge at the appropriate time; an anorectal sensory apparatus that can
discriminate the quantity and quality of content and a very complex sphincter mechanism that is
closed at rest and can relax and allow the content to pass.
The rehabilitation of a patient who has suffered the loss of the rectum and the anus has been the
objective of medicine for some time, the descent of the colon and the colo-perineal anastomosis
are procedures that can bring comorbidities; Most authors have done direct anastomosis, but
some do coloplasty and others do a “J” pouch.
In the reconstruction of the internal sphincter, several techniques have been done, one of them
consists of using the muscular layer of the colon placed in a spiral fashion, wrapping the distal part
of the descending part, a plasty has also been performed placing smooth muscle as a sleeve
around the distal part of the lowered colon.
The reconstruction of the sphincter mechanism has been done with graciloplasty that was
described more than 60 years ago, in the beginning, myoneural electro-stimulation was not used
but the type II muscle fibers that are present in this muscle have a tendency to fatigue and in the
80s With electrostimulation, the possibility of changing these fibers to fatigue-resistant type I was
seen. The artificial anal sphincter, the myocutaneous flap with rectus abdominis, has also been
used. The final part of the rectum has been replaced with a transposition of the anthropyloric
valve and the colo-anal descent has been performed without a sphincter mechanism with an
antegrade Malone enema.
We have done our technique with descent of the colon and then the construction of the sphincter
mechanism with transposition of the gluteus maximus, we have chosen it because the gluteus is a
voluminous muscle, it is close to the anal region and the contraction of the muscle is a normal
response when the fecal matter discharge is imminent. We are going to show our experience with
this technique in the conference.