Current aspects and future prospects of total anorectal reconstruction - a critical and comprehensive review of the literature

PURPOSE: Many rectal cancer patients undergo abdominoperineal excision worldwide every year. Various procedures to restore perineal (pseudo-) continence, referred to as total anorectal reconstruction, have been proposed. The best technique, however, has not yet been defined. In this study, the different reconstruction techniques with regard to morbidity, functional outcome and quality of life were analysed. Technical and timing issues (i.e. whether the definitive procedure should be performed synchronously or be delayed), oncological safety, economical aspects as well as possible future improvements are further discussed. METHODS: A MEDLINE and EMBASE search was conducted to identify the pertinent multilingual literature between 1989 and 2013. All publications meeting the defined inclusion/exclusion criteria were eligible for analysis. RESULTS: Dynamic graciloplasty, artificial bowel sphincter, circular smooth muscle cuff or gluteoplasty result in median resting and squeezing neo-anal pressures that equate to the measurements found in incontinent patients. However, quality of life was generally stated to be good by patients who had undergone the procedures, despite imperfect continence, faecal evacuation problems and a considerable associated morbidity. Many patients developed an alternative perception for the urge to defecate that decisively improved functional outcome. Theoretical calculations suggested cost-effectiveness of total anorectal reconstruction compared well to life with a permanent colostomy. CONCLUSIONS: Many patients would be highly motivated to have their abdominal replaced by a functional perineal colostomy. Given the considerable morbidity and questionable functional outcome of current reconstruction technique improvements are required. Tissue engineering might be an option to design an anatomically and physiologically matured, and customised continence organ.

A critical literature review of high-performance corrosion reinforcements in concrete bridge applications /

"HRDI-10/07-04(1M)E"--P. [4] of cover.

A critical technical review of six hazard assessment models /

Final report, issued March 1977.

Fundamentals of combustion of gaseous fuels; a critical literature review,

Mode of access: Internet.

Critical and historical essays contributed to the Edinburgh review /

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Parliamentary history and review : containing reports of the proceedings of the two houses of parliament during the session of 1825: --6 Geo. IV, with critical remarks on the principal measures of the session.

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Critical essays contributed to the Eclectic review /

Vol. 1, 1868.

Critical and historical essays contributed to the Edinburgh review /

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Critical essays contributed to the Eclectic review,/

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Sacred literature; comprising a review of the principles of composition laid down by the late Robert Lowth ... in his Praelections, and Isaiah: and an application of the principles so reviewed, to the illustration of the New Testament; in a series of critical observations on the style and structure of that sacred volume. By the Rev. John Jebb.

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Remarks, critical and historical, on an article in the forty-seventh number of the North American review, relating to Count Pulaski : addressed to the readers of the North American review /

Reply to Louis Hue Girardin's "Pulaski vindicated from an unsupported charge inconsiderately or malignantly introduced in Judge Johnson's Sketches of the life and correspondence of Major Gen. Nathaniel Greene."

Lives of the most eminent English poets: with critical observations on their works. To which are added the "Preface to Shakespeare," and the review of "The origin of evil."

Mode of access: Internet.