[Gluteus maximus transplantation for fecal incontinence after surgery of high anal atresia].
OBJECTIVE
To investigate the application of gluteus maximus transplantation for fecal incontinence after surgery of high anal atresia.


METHODS
Between December 2002 and November 2010, 25 patients with fecal incontinence were treated with gluteus maximus transplantation, which was caused by surgery of high anal atresia. There were 11 males and 14 females with an average age of 10.2 years (range, 3-22 years). Preoperative radiography, anorectal manometer, and electromyogram showed abnormality or deficiency of anal sphincter function. Wexner score, Fecal Incontinence Quality of Life (FIQL) questionnaire, and Self-rated Health Measurement Scale Version 1.0 (SRHMS) score were used to evaluate life quality of the patients. The anorectal manometer, intra-rectal ultrasound examination, and defecation radiography were performed.


RESULTS
Healing of incision by first intention was achieved in 23 cases and rectal-wound fistula occurred in 2 cases. The follow-up time was 1 to 9 years (mean, 6.3 years). Defecation frequency was decreased from more than 10 times to 4-6 times every day. Wexner score and SRHMS were significantly improved at 1 or 2 years after surgery when compared with preoperative socres (P < 0.05). FIQL was also significantly improved after 2 years (P < 0.05). At 2 years after surgery, the anal maximum systolic pressure, contraction duration, and maximum systolic volume were improved, showing significant differences when compared with those at preoperation and 1 year after surgery (P < 0.05).


CONCLUSIONS
Gluteus maximus transplantation can improve defecation controls in the patients with fecal incontinence after surgery of high anal atresia.
Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan 610041, PR China.
Feiteng
F
Kong
Fuyu
F
Li
Juxian
J
Liu
Yongmei
Y
Chen
Yang
Y
Wu
Xiaodong
X
Yang
Bo
B
Xiang
D000293:Adolescent; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D001006:Anus, Imperforate / Q000503:physiopathology / Q000601:surgery*; D002081:Buttocks / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009119:Muscle Contraction / Q000502:physiology; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012007:Rectum / Q000503:physiopathology / Q000601:surgery; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult