2000 Fiscal Year Final Research Report Summary
Development of procedures for fecal incontinence with sphincter atrophy by means of the cross-innervation between the pudendal nerve and the motor nerve to the lower limb
| Project/Area Number |
10671214
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Digestive surgery
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| Research Institution | JICHI MEDICAL SCHOOL |
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Principal Investigator |
SATO Tomoyuki Jichi Medical School, Dept of Surgery, Josyu, 医学部, 助手 (50225976)
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| Co-Investigator(Kenkyū-buntansha) |
SEGAWA Satoru Jichi Medical School, Dept of Surgery, Josyu, 医学部, 助手 (80254928)
KONISI Fumio Jichi Medical School, Dept of Surgery, Professor, 医学部, 教授 (20142242)
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| Project Period (FY) |
1998 – 2000
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| Keywords | pudendal nerve / innervation / fecal incontinence / surgery |
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| Research Abstract |
The aim of this study was to develop two kinds of procedures for the treatment of fecal in continence.
First experiment (cross nerve in nervation method) : On 14 sides of eight dogs, the transected proximal end of the nerve in nervating the biceps femoris muscle was microsurgically cross-transferred to the distal end of the transected pudendal nerve. The external anal sphincter was analyzed by electromyography and adenosine 5'-triphosphatase staining at three months after surgery. RESULTS : On 13 of 14 sides, the external anal sphincter was well preserved and the evoked potential was clearly recorded. CONCLUSIONS : The cross-nerve transfer procedure in a dog model was found to prevent muscular atrophy of the external anal sphincter when performed immediately after pudendal nerve transection.
Second experiment (end to side nerve anastomosis method) ; On the right side of each dog, the distal end of the transected nerve innervating the biceps femoris muscle was anastomosed to the perineural window of the pudendal nerve, where the epineurium was excised over a small area without injuring the funiculus. Reinnervation was studied 5 months after the operations. The left side of the dogs was used as a control. RESULTS : After end-to-side pudendal nerve anastomosis, the biceps femoris muscle contracted with the evoked potential in 5 dogs (71%) and demonstrated electric activity at rest in 3 dogs (43%), but there was no reflex activity after anal stimulation. Regenerated myelinated axons were observed in a cross section of the anastomosed nerve in 6 dogs. CONCLUSIONS : End-to-side pudendal nerve anastomosis is a promising technique for the creation of an anal sphincter in patients who have fecal in continence. The technique preserved the original external anal sphincter and created a skeletal muscle that was innervated by the pudendal nerve in 71% of the dogs studied
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