Traumatic anal incontinence. Role of unilateral gluteus maximus transposition supplementing and supporting direct anal sphincteroplasty.

Abstract

This study was designed to describe the surgical technique and discuss the possible beneficial role of unilateral gluteus maximus transposition supplementing and supporting a tensile-direct anal sphincteroplasty. Based on our experience with bilateral gluteus transposition, direct apposition of the remaining muscular ends combined with unilateral gluteus transposition (to avoid the tendency of the sphincter ends to separate) was undertaken in two patients with severe destruction of more than half of the anal muscular ring. Both postoperative courses were uneventful. Three months after colostomy closure, both patients were classified as Pescatori's B1. As with any other combined surgical technique, the benefit derived may be attributed entirely to one of the procedures, but it is our impression that the gluteus transposition was worthwhile in achieving satisfactory repair.