Anorectal reconstruction using graciloplasty after abdominoperineal resection: A review of the current literature and recommendations for the future

Background: Anorectal reconstruction with the gracilis muscle following abdominoperineal resection (APR) is an option for patients who do not want a permanent abdominal stoma. Despite some promising results, significant heterogeneity still exists in the method and timing of surgery, as well as the use of electrical stimulation. Aim: We review the literature so as to make the best recommendations for the use of this procedure. Method: Nine of the latest publications were reviewed looking at primary versus secondary reconstruction, use of electrostimulation, double versus single graciloplasty, surgical techniques, complications, functional outcomes, and patient selection. Conclusion: Graciloplasty should be performed as a delayed procedure about three years after APR so as to exclude those who develop recurrence or otherwise adapt well to the abdominal stoma. Single muscle graciloplasty can be performed with good results and an electrical stimulator should only be implanted if continence cannot be achieved after biofeedback training.