First Anorectal Transplant on Human Cadaver

First Anorectal Transplant on Human Cadaver
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The things we take for granted are often the very things that we can't live without. A perfect example of this is pooping.

Frequently mocked for its accompanying stench and embarrassing noises, defecation allows for the removal of solid waste from our bodies. When this vital function is lost, disconcerting problems can rapidly arise.

Unfortunately, such a loss happens to many people each year. Injuries, cancer, severe fecal incontinence, diverticulitis, and fistulas arising from inflammatory bowel disease are a few conditions that can damage the colon to such a degree that feces can no longer leave the anus. A common solution is colostomy. Here, the damaged part of the colon or rectum is removed and the healthy part is rerouted to a constructed opening in the patient's midsection, allowing waste to exit.

But for obvious reasons, this remedy is far from optimal. Most who undergo colostomies must constantly carry around an attached bag to collect feces.

For the last decade or so, doctors and surgeons have been contemplating a new "supreme" method for restoring the ability to defecate: a complete anorectal transplant. Here, the distal portion of the digestive tract, including the entire anal canal and the last two centimeters of the rectum, are removed from a deceased donor and implanted in a recipient. Surgeons have already successfully completed the procedure in pigs, dogs, and rats, but haven't yet attempted it in humans. Until now.

Using two female cadavers, Japanese surgeons carried out the complete transplantation for the first time. The entire process took seven hours.

Next up, the researchers plan to attempt live transplantations in dogs and monkeys, accompanied by long-term observational studies to ensure healthy outcomes.

If the current method is one day perfected, anorectums could be donated just like other organs, like the heart, liver, and kidney. The procedure will allow people who have lost the ability to defecate to regain this essential function.

"Considering recent advances in operational techniques and transplantation medicine, anorectal transplantation may follow the success of other vascularized composite allotransplants in humans, including those of the limb, face, larynx, and uterus," the authors conclude.

Source: Araki J, Nishizawa Y, Sato T, Naito M, Akita K, et al. (2013) Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation. PLoS ONE 8(7): e68977. doi:10.1371/journal.pone.0068977

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