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Perineal Antropylorus Transposition for End-Stage Fecal Incontinence in Humans: Initial Outcomes

Chandra, Abhijit M.Ch.1; Kumar, Ashok M.S.1; Noushif, M. M.S.1; Gupta, Vishal M.Ch.1; Singh, Devendra M.S.2; Kumar, Manoj M.D.3; Srivastava, R. N. M.S.4; Ghoshal, U. C. D.M.5

Diseases of the Colon & Rectum: March 2013 - Volume 56 - Issue 3 - p 360–366
doi: 10.1097/DCR.0b013e31827571ad
Original Contribution: Pelvic Floor

BACKGROUND: Technical feasibility of perineal antropyloric valve transposition to reconstruct a severely damaged incontinent anal sphincter or to replace an excised anorectal sphincter has been reported previously.

OBJECTIVE: This study aimed to document the follow-up results of patients who underwent successful perineal antropyloric valve transposition for end-stage fecal incontinence.

SETTING: This study was conducted at a single tertiary care institution.

PATIENTS: Seventeen patients underwent the procedure. Eight patients had replacement (group 1) and 9 patients had augmentation (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 18 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 celiac CT angiography. Anal manometry showed a significant (p = 0.03) rise in the postoperative resting neosphincter 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 with higher scores in group 2 than in group 1 on follow-up.

LIMITATIONS: A longer follow-up with a larger sample size is required.

CONCLUSIONS: Antropyloric valve transposition can be used effectively for a selected group of patients with end-stage fecal incontinence. Patients undergoing anal sphincter augmentation have better outcomes in comparison with those having an excised sensate anorectum.

1 Department of Surgical Gastroenterology, King George’s Medical University, Lucknow, India

2 General Surgery, King George’s Medical University, Lucknow, India

3 Radiodiagnosis, King George’s Medical University, Lucknow, India

4 Orthopaedics, King George’s Medical University, Lucknow, India

5 Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Funding/Support: This study was supported by grant 2835/Lekha/09 from the Department of Surgical Gastroenterology, King George Medical University, India.

Financial Disclosure: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012.

Correspondence: Abhijit Chandra, M.Ch., Department of Surgical Gastroenterology, Chhatrapati Shahuji Maharaj Medical University (formerly King George Medical University), Lucknow, India, 226003. E-mail:

© The ASCRS 2013