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Bilateral gluteus maximus transposition for anal incontinence
J Christiansen1, C R Hansen, O Rasmussen
1Department of Surgery D, Herlev Hospital, University of Copenhagen, Denmark.
The British Journal of Surgery
|July 1, 1995
Summary
Bilateral gluteus maximus transposition for anal incontinence showed limited success, with only three of seven patients experiencing improved continence. This surgical approach did not demonstrate superior outcomes compared to unstimulated graciloplasty for fecal incontinence.
Area of Science:
- Colorectal Surgery
- Pelvic Floor Disorders
- Surgical Innovation
Background:
- Anal incontinence significantly impacts quality of life.
- Previous surgical interventions for anal incontinence often fail.
- Alternative reconstructive techniques are continuously explored.
Purpose of the Study:
- To evaluate the efficacy of bilateral gluteus maximus transposition in patients with refractory anal incontinence.
- To assess the impact of this procedure on anorectal physiology and patient continence.
- To compare outcomes with other surgical options like unstimulated graciloplasty.
Main Methods:
- Seven patients (5 female, 2 male) with a history of failed anal incontinence surgery underwent bilateral gluteus maximus transposition.
- Patients had a history of incontinence to solid stool, with varied prior surgical interventions.
- Anorectal manometry and rectal sensitivity assessments were performed post-operatively.
Main Results:
- Three out of seven patients reported improved continence after over a year of follow-up; four showed no change.
- Wound infection occurred in three patients, necessitating drainage in two.
- Anorectal physiology revealed moderately increased resting and squeeze pressures in improved patients, but rectal volume tolerance remained limited.
Conclusions:
- Bilateral gluteus maximus transposition demonstrated limited success in improving anal incontinence in this small patient cohort.
- The procedure did not significantly enhance rectal volume tolerance or sensitivity.
- Current findings suggest that gluteus maximus transposition may not offer superior results to unstimulated graciloplasty for anal incontinence.