Graciloplasty following Rectal Excision – the Total Anorectal Reconstruction (TAR) Anal sphincter reconstruction by means of electrically stimulated (dynamic) graciloplasty offers a new treatment option for patients with severe fecal incontinence or for those who require abdominoperineal resection (APR) for cancer. During the period 1992–2001, 38 patients underwent TAR either synchronously following APR (primary TAR) (n = 28) or as a secondary procedure (n =10) 1–5 years after rectal excision. The most prominent complication was an injury or arrosion of the neorectum or neoanus (n =10), which could be avoided by increasing experience with this method. Defecation disorders with consecutive incontinence were observed as the major functional problem and could be overcome by periodical irrigations. Although sphincter replacement by TAR following APR reveals worse functional results compared to patients treated with dynamic graciloplasty for fecal incontinence and must be regarded only as a compromise, it is a treatment option which can be offered to selected patients.

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