title: Use of the gluteus maximus muscle as the neosphincter for restoration of anal function after abdominoperineal resection.
abstract: BACKGROUND
  Our aim was to evaluate complications and long-term functional outcome in patients who had sphincter reconstruction using the gluteus maximus muscle as the neosphincter after abdominoperineal resection for rectal cancer treatment.
  
  
  METHODS
  Seven patients underwent reconstruction from 2000 to 2010. First, the sigmoid colon was brought down to the perineum as a perineal colostomy, with the procedure protected by a loop ileostomy. Reconstruction of the sphincter mechanism using the gluteus maximus took place 3 months later, and after another 8-12 weeks, the loop ileostomy was closed. We studied the functional outcome of these interventions with follow-up interviews of patients and objectively assessed anorectal function using manometry and the Cleveland Clinic Florida (Jorge-Wexner) fecal incontinence score.
  
  
  RESULTS
  The mean follow-up was 56 months (median 47; range 10-123 months). One patient had a perianal wound infection and another had fibrotic stricture in the colocutaneous anastomosis that required several digital dilatations. Anorectal manometry at 3-month follow-up showed resting pressures from 10 to 18 mm Hg and voluntary contraction pressures from 68 to 187 mm Hg. Four patients had excellent sphincter function (Jorge-Wexner scores ≤5).
  
  
  CONCLUSIONS
  Our preliminary results show that sphincter reconstruction by means of gluteus maximus transposition can be effective in restoring gastrointestinal continuity and recovering fecal continence in patients who have undergone APR with permanent colostomy for rectal cancer. Furthermore, the reconstruction procedure can be performed 2-4 years after the APR.
authors.affiliation: Department of General Surgery, Universidad Pontificia Bolivariana, Clínica de Las Américas, Diagonal 75B #2A-80/308, Medellín, Colombia. puerta58@gmail.com
authors.forename: J D
authors.initials: JD
authors.lastname: Puerta Díaz
authors.forename: R
authors.initials: R
authors.lastname: Castaño Llano
authors.forename: L J
authors.initials: LJ
authors.lastname: Lombana
authors.forename: J I
authors.initials: JI
authors.lastname: Restrepo
authors.forename: G
authors.initials: G
authors.lastname: Gómez
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D002081:Buttocks / Q000601:surgery; D015331:Cohort Studies; D003125:Colostomy / Q000379:methods; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D010502:Perineum / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology