Autologous Anorectal Transplantation Galvao FH et al. The infrarenal aorta and vena cava were isolated and cross- clamped, and the graft was implanted by arterial and venous anastomoses between the IMA and the aorta (Figure 1B) and the IMV and vena cava (Figure 1C). After reperfusion (Figure 1D), the entire graft was placed inside the abdominal cavity, and the pudendal nerve was reconstructed (Figure 1E). Finally, the anus was placed in its original position, and the perineum was closed (Figure 1F). Digestive tract continuity was reestablished by an end-to-end colorectal anastomosis. The abdominal cavity was closed, and the animals were observed for an additional two hours. At the end of the experiment, the graft was removed for histological analysis. The average times for graft recovery and implantation (including vascular, ner- vous and GI reconstruction) were 57 and 99 minutes, respectively. No problems regarding graft perfusion were observed at the end of the experiment. Histological graft assessment showed normal aspects in one graft and mild ischemia-reperfusion injury in two. To the best of our knowledge, there is only one report of a pre-clinical model of anorectal transplantation (5). Those authors described the donor and recipient surgical technique in four swine allotransplantations, with a 25% rate of technical failure after a 24-hour observation period. The experimental model described in this paper mimics the surgical stress and potential effects of graft denervation of allotransplantation but precludes, for obvious reasons, the antigen-mediated immune response. In addition, the technical modifications were associated with a significant reduction in the surgical time and cost. Therefore, anorectal autotransplantation in swine is a feasible and relatively simple procedure that may be a relevant technique to study regeneration, anorectal physiology, and the potential benefits of this unique type of transplantation without the interference of immune-mediated effects. CLINICS 2012;67(8):971-972 ACKNOWLEDGMENTS This study was supported by Laboratory of Medical Investigation (LIM37), University of Sa˜o Paulo School of Medicine. AUTHOR CONTRIBUTIONS Galvao FH conceived and designed the study, provided the hypothesis, performed the operative procedure, was responsible for the data analysis and interpretation, manuscript writing and approval of the manuscript final version. Seid VE conceived and designed the study, provided technical help with the operative procedure, was responsible for the data analysis, interpretation of results and approval of the manuscript final version. Waisberg DR conceived and designed the study, provided technical help with the operative procedure, was responsible for the data analysis and interpretation of results. Cruz Jr RJ conceived and designed the study, provided advice and consultation, was responsible for the manuscript writing, critical review and approval of the manuscript final version. Hirano H and Catanozi S provided technical help with the operative procedure, were responsible for the data analysis and interpretation of results. Chaib E and D’Albuquerque LA provided advice and consultation, were responsible for the manuscript writing and approval of the manuscript final version. REFERENCES 1. Wald A. Fecal incontinence in adults. New Engl J Med. 2007;356(16):1648- 55, http://dx.doi.org/10.1056/NEJMcp067041. 2. Galvao FHF, Seid VE, dos Santos RMN, Kitamura M, Galvao RD, Pinto RA, et al. Anorectal transplantation. Tech Coloproctol. 2009;13(1):55-9, http://dx.doi.org/10.1007/s10151-009-0459-5. 3. Galvao FHF, Waisberg DR, Vianna RMD, Galvao RD, Seid VE, Andraus W, et al. Intestinal transplantation including anorectal segment in the rat. Microsurg. 2012;32(1):77-9, http://dx.doi.org/10.1002/micr.20958. 4. Araki J, Mihara M, Narushima M, Iida T, Sato T, Koshima I. Vascularized Anal Autotransplantation Model in Rats: Preliminary Report. Transplant P. 2011;43(9):3552-6, http://dx.doi.org/10.1016/j.transproceed.2011.08.042. 5. O’Bichere A, Shurey S, Sibbons P, Green C, Phillips RKS. Experimental model of anorectal transplantation. Brit J Surg. 2000;87(11):1534-9, http://dx.doi.org/10.1046/j.1365-2168.2000.01557.x. 972