Background

Although, in recent years, the use of mechanical staplers has significantly extended the indications for sphincter-saving operations, abdominoperineal resection (APR) is still an option in the surgical treatment of cancer of the low rectum. In fact, in patients with very low rectal tumours or tumours of the anal canal, rectal resection is the treatment of choice [1, 2]. In these patients a definitive colostomy represents both an anatomical impairment and a psychological handicap, and significantly impairs quality of life (QoL) [3].

The first attempt at perineal colostomy was made in 1930 by Chittenden using a flap of the gluteus maximus as a neo-sphincter [4]. In 1950, Margottini reported a series of 90 patients with a perineal colostomy following resection of the rectum [5]. In 1952 Pickrell reported the results of graciloplasty to treat anal incontinence in children [6]. In 1986 Cav-ina [7] presented his initial experience of anorectal reconstruction following Miles resection adding elec-trostimulation (EMS) of the transposed muscle in order to prevent atrophy and improve its performance. In 1989, Williams [8] published the results of his experience with perineal colostomy and gracilo-plasty following rectal resection, associated with an implantable system. Other experiences of this subject were subsequently reported by Cavina [9-11], Beaten [12] and Williams [13,14].

The implantation of an artificial bowel sphincter (ABS Acticon ABS - American Medical Systems, Minneapolis, MN, USA) has been carried out in patients with faecal incontinence (FI) [15-19]. We believe this procedure might be useful in patients previously submitted to Miles procedure.

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