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

대한대장항문학회지 2013년 29권 1호 p.7 ~ 11
 ( Chandra Abhijit ) - Chhatrapati Shahuji Maharaj Medical University Department of Surgical Gastroenterology

 ( Kumar Ashok ) - Chhatrapati Shahuji Maharaj Medical University Department of Surgical Gastroenterology
 ( Noushif M ) - Chhatrapati Shahuji Maharaj Medical University Department of Surgical Gastroenterology
 ( Gupta Nitish ) - Chhatrapati Shahuji Maharaj Medical University Department of Surgical Gastroenterology
 ( Kumar Vijay ) - Chhatrapati Shahuji Maharaj Medical University Department of Plastic Surgery
 ( Chauhan Navneet Kumar ) - Chhatrapati Shahuji Maharaj Medical University Department of Anatomy
 ( Gupta Vishal ) - Chhatrapati Shahuji Maharaj Medical University Department of Surgical Gastroenterology

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.

키워드

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