Background: Anorectal reconstruction with the gracilis muscle following
abdominoperineal resection (APR) is an option for patients who do not want a
permanent abdominal stoma. Despite some promising results, significant
heterogeneity still exists in the method and timing of surgery, as well as
the use of electrical stimulation. Aim: We review the literature so as to
make the best recommendations for the use of this procedure. Method: Nine of
the latest publications were reviewed looking at primary versus secondary
reconstruction, use of electrostimulation, double versus single
graciloplasty, surgical techniques, complications, functional outcomes, and
patient selection. Conclusion: Graciloplasty should be performed as a delayed
procedure about three years after APR so as to exclude those who develop
recurrence or otherwise adapt well to the abdominal stoma. Single muscle
graciloplasty can be performed with good results and an electrical stimulator
should only be implanted if continence cannot be achieved after biofeedback
training.