08 November 2016ChennaiAn young woman lost her anal muscles in an accident. In a surgery that is not performed very often, surgeons at LIMA rebuilt her anus using muscle fibers taken from her thigh.
Ms. NL, a 19-year-old Civil service aspirant, was traveling by road while she met with an accident that changed her life. She woke up on the hospital bed only to find out that a leg had been amputated and was only a stump. Even worse, she found that she had a bag attached to her belly, and all motion and gas was being passed out and collected into the bag. The accident had severed not only her leg, but had also destroyed the muscles of the anus, and this resulted in the colostomy (opening of the colon on to the skin).
After being turned away by various doctors in the city, Ms. NL took a chance at our hospital about 20 months ago. A series of tests were done, to understand the damaged anatomy of the anus. Followed by this, Dr. J.S. Rajkumar and team decided to create an artificial anus for her, using the muscles of the inner thigh as substitute for the anal muscles. There began our pursuit for creation of an artificial anus!
The anal sphincter muscle
The anus is made up of high endurance muscle fibers. Slow, steady and continuous contractions of these muscles help keep the anal sphincter closed, maintaining continence. Trauma affecting this region might result in loss of function of this sphincter muscle, leading to loss of control over passing motion (incontinence).
A destructed anus such as this can be reconstructed using the Gracilis muscle from the thigh. This procedure is known as Graciloplasty.
Our Minor Miracle with Graciloplasty
This is indeed a challenging procedure, taking into consideration the difference in endurance level and speed of contraction of the thigh muscles as compared to the anal sphincter muscle. The muscles taken from the thigh are fast twitch fibers that contract quickly and have low endurance capacity. In contrast, the anal muscle with slow twitch muscle fibers contracts slowly, for a longer period of time and has high endurance to stress.
However, surgical advancements have made it possible to convert these fast twitching thigh muscle fibers into slow twitching fibers. This can be achieved by chronic low frequency electrical stimulations. Long-term stimulation using electrical current slows down muscle contractions and makes them weaker, in turn increasing muscle endurance. The process itself takes several months, requiring much skill and precision.
The Creation of Artificial Anus
Our team of surgeons therefore began a series of electrical treatments on the muscles of both her thighs, to change them fast to slow muscles. When this was completed, the process itself taking several months, the sphincter and thigh muscles were assessed. An artificial anal sphincter was then created from the thigh muscles in another 6 months time by, gradually widening the thigh muscles around the anus and then stitching them to the backbone. The new anus was trained for several weeks. During this time, the colostomy bag still remained.
After Successful Surgery
Towards the end of these weeks, her persistence, hard work and determination ultimately helped Ms. NL gain control over her feces, through her newly placed anus. After assessing the capacity and compliance of the rectum, we were able to successfully remove the colostomy bag away.
The last 1 ½ months has been a wonderful period in her life and Ms. NL is now able to control her motion and gas perfectly. She has thus reached pre accident level of sphincter control at last.
This not only highlights the detailed efforts by our group of specialists, headed by Dr. J. S. Rajkumar, over nearly 2 years, but also underlies the extraordinary strength of this young lady throughout the treatment period.