eP491 - Fluorescence Enhanced Composite Antropyloric Gluteus Maximus Transposition for Neoanal Reconstruction

Sunday, June 2, 2024

4:36 PM – 4:41 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

Author(s)

AC

Abhijit Chandra, MD, MCh

Head of the department, Surgical gastroenterology
King George's Medical University
King George Medical University,KucknowIndia
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.

Author(s)

PR

Pritheesh Rajan, MS, MCh

Assistant professor
King George's Medical University
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.
DG

Deeban Ganesan, MD

Senior Resident
King George's Medical University
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.
AM

ARUN Manoharan, MS

Senior Resident
KING GEORGE MEDICAL UNIVERSITY
puducherry, Puducherry, India

Disclosure information not submitted.
US

Utkarsh Srivastava, n/a

Assistant Professor
Surgical Gastroenterology, King George's Medical University, Lucknow
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.
MD

Mukteshwar Dasari, MCH

Assistant professor in the Department of surgical gastroenterology
Kings goerge medical university
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.
YS

Yash Vardhan Sinha, n/a

Assistant Professor
Department of Surgical Gastroenterology,King George Medical College
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.

ePoster Presenter(s)

JS

Julie Nishant Shah, M.S.

Resident
King George Medical University
Ahmedabad, Gujarat, India

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Purpose/Background: End stage fecal incontinence requiring permanent stoma has a significant negative impact on physical, mental and social well-being of the patient. Besides affecting the quality of life, it imparts a considerable economic burden to the patient in this part of the world. We had earlier described Composite Antropyloric (AP) Gluteus Maximus Transposition as a novel method of Neoanal Reconstruction. We now describe its modification using ICG enhanced Intraoperative Navigation to improve vascularity and survival of the perineally transposed graft.Methods/Interventions: Three consecutive patients requiring permanent colostomy following failed conventional treatments were included. Patients were evaluated for anatomic integrity (using MRI pelvis, 3D ultrasonography, sigmoidoscopy), Functional status (using Saline retention test, High definition Manometry to measure resting and squeeze sphincter pressures) and subjective assessment using SIMS and locally validated Qol score. In the first stage, the patients underwent transposition of AP valve to the perineum. During this procedure, ICG was used to delineate gastroepiploic arcade and preserve the infrapyloric vessels and objectively determine the vascularity of APV graft before its perineal transposition. As a second stage, inferior half of the Gluteus maximus was wrapped around the perineally transposed AP graft based on the inferior gluteal artery visualised by ICG. Finally, bowel continuity was restored. Three months thereafter the procedure we assessed the continence of the patient using the above mentioned criteria.Results/Outcomes: Between January 2022 to June 2023, three patients underwent the procedure. Etiology for fecal incontinence in these patients were grade 5 perineal injury in 2 patients and congenital ARM in one patient. Intraop completeness of GE arcade and preservation of infrapyloric vessels were accomplished in all 3 patients using ICG. No supercharging of the APV graft was required. There was significant improvement in the SMIS scores (22 vs 8), post-operative mean resting (12.25 vs 22.45 mmHg) and squeeze (20.63 vs 110.18 mmHg) pressures. On personal interview all patients were satisfied with their quality of life. One patient had wound infection at the pylorus transposed site and one patient had wound infection at the colostomy site which were managed conservatively.Conclusion/

Discussion: ICG navigation aids the surgeon intraoperatively to define the pedicle, ascertain the vascularity of the transposed graft which may improve outcomes. Fluorescence Enhanced Composite Antropyloric/ GM reconstruction could be a more reliable alternative for patients with end stage fecal incontinence.