[Surgical treatment of anal insufficiency]

Organic defects in the lateral walls of the rectal obturative apparatus involving no more than one fourth of its circumference are repaired by end-to-end or side-to-side sphincteroplasty. Sphincterolevatoroplasty is indicated in anterior or posterior defects and sphincterogluteoplasty with short or long grafts of the greatest gluteus muscles in larger defects. For cases in which the gluteal muscles cannot be used, an operation has been developed for repair of the defects with the medial part of the great adductor muscle. A damaged internal sphincter muscle of the anus is reconstructed by means of a muscular cuff formed from the wall of a pulled down rectum.