Anorectal continence following sphincter reconstruction utilizing the gluteus maximus muscle: a case report

Rectal incontinence following pull-through procedure for high imperforate anus remains a difficult problem. Based on recent knowledge of the segmental neurovascular supply of the gluteus maximus muscle, the inferior half of the muscle on both sides was used for anorectal sphincter reconstruction on a 10-year-old boy who was totally incontinent following a pull-through procedure for a high imperforate anus. The technique of constructing this sphincter is simple and utilizes principles of muscle tendon transfer without jeopardizing the function of gait. Furthermore, the gluteus maximus muscle, being an accessory muscle of anal continence, is an ideal structure for this reconstruction. Colostomy can be prevented with the use of good preoperative bowel preparation and a constipating program for 1 week postoperatively. The results are directly related to the success of the operative procedure, and the maturity and degree of motivation of the child to undergo bowel-control training.