Ann Coloproctol.  2013 Feb;29(1):7-11. 10.3393/ac.2013.29.1.7.

Feasibility of Neurovascular Antropylorus Perineal Transposition With Pudendal Nerve Anastomosis Following Anorectal Excision: A Cadaveric Study for Neoanal Reconstruction

• Chandra A
• Kumar A
• Noushif M
• Gupta N
• Kumar V
• Chauhan NK
• Gupta V

• KMID: 1424739
• DOI: http://doi.org/10.3393/ac.2013.29.1.7

Abstract

PURPOSE
Perineal transposition of the antropyloric valve following an anorectal excision as a substitute for a permanent colostomy has recently been reported in humans. However, the problem of neural control still remains in these patients. Our aim herein was to study the anatomical feasibility of an anastomosis between the pudendal nerve branches (inferior rectal nerve) innervating the external anal sphincter and the anterior vagal branches of the perineally-transposed antropyloric segment in cadavers.
METHODS
The antropyloric segment, along with its carefully dissected branch of the anterior vagus, was mobilized based on the left gastroepiploic pedicle in six fresh human cadavers. The antropyloric valve was then transposed in the perineum after the pudendal nerve branches had been dissected out, and an approximation of these two nerves was performed to ascertain the technical feasibility of their neural anastomosis.
RESULTS
The anterior vagus innervating the antropylorus could be harvested in all cadavers below the hepatic division of the main vagus trunk. The inferior rectal nerve or its branches were found consistently around the 3 or the 9 o'clock position in the ischioanal fossa. An anatomical tension-free approximation of the anterior vagus branch (of the transposed antropyloric segment) to the inferior rectal nerve in the perineum was feasible in all the cadavers studied.
CONCLUSION
An inferior rectal nerve anastomosis with the anterior vagal branch of the perineally-transposed antropyloric segment can be achieved anatomically. This preliminary step can be the basis for future animal studies and subsequent clinical application of the procedure for possible neural control of the transposed antropyloric segment in the perineum.

Keyword

Anal sphincter; Colostomy; Pudendal nerve; Pylorus; Vagus nerve

MeSH Terms

Anal Canal
Animals
Cadaver
Colostomy
Humans
Perineum
Pudendal Nerve
Pylorus
Vagus Nerve