CLINICS 2012;67(8):971-972 TECHNICAL NOTE DOI:10.6061/clinics/2012(08)20 An innovative model of autologous anorectal trans- plantation with pudendal nerve reconstruction Flavio Henrique Ferreira Galvao, Victor Edmund Seid, Daniel Reis Waisberg, Ruy Jorge Cruz-Jr, Hugo Hirano, Sergio Catanozi, Eleazar Chaib, Luiz Augusto Carneiro D’Albuquerque Faculdade de Medicina da Universidade de S a˜o Paulo, Department of Gastroenterology, Division of Transplantation, Laboratories of Medical Investigation (LIM37 and LIM10), Sa˜ o Paulo/SP, Brazil. Email: fgalvao@usp.br Tel.: 55 11 3061 8319 Figure 1 - (A) An anorectal graft showing the inferior mesenteric artery (IMA) and vein (IMV) and the rectum (R). (B) The infrarenal aorta (Ao) and vena cava (IVC) were cross-clamped at the site of anastomosis. (C) The anastomoses between the Ao and IMA and between the IVC and IMV. (D) The anorectal graft following reperfusion. (E) Pudendal nerve anastomosis (arrow head). (F) Anal anastomosis in the perineum. Fecal incontinence is an important public health problem that has a significant impact on the quality of life of individual patients. The prevalence of fecal incontinence in the United States ranges from 2 to 17%, but this may be an under- estimation (1). The current treatments for severe fecal incontinence are often complex and have disappointing results (1). Anorectal transplantation may be a definitive method for restoring normal sphincter function in these patients. We and others have previously investigated anor- ectal transplantation in rats with promising results (2-4). Copyright 2012 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. No potential conflict of interest was reported. However, there is a lack of pre-clinical large animal models to study the potential benefits of this procedure. In this paper, we describe an innovative surgical technique of anorectal auto- transplantation, which allows for physiological studies with- out the immunologic effects related to allotransplantation. The technique was initially performed in three swine weighing 25-35 Kg. After general anesthesia, an abdominal and perineal incision was performed in which the rectum, anal sphincter, and skin surrounding the anus were procured en bloc. The graft’s vascular pedicle contained the inferior mesenteric artery (IMA) with a patch of the aorta and inferior mesenteric vein (IMV), which was divided near the splenic vein (Figure 1A). The pudendal nerve was carefully isolated and transected. The graft was removed and immediately flushed with 250 ml of cold heparinized preservation solution through a catheter inserted in the IMA. The graft was then placed in a cooler with cold solution without heparin for a total of 20 minutes. 971