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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.

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