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CC BY-NC-ND 4.0 · Indian J Plast Surg 2023; 56(01): 022-030
DOI: 10.1055/s-0042-1759499
Original Article

Unstimulated Gluteus Maximus Sphincteroplasty for Bowel Incontinence

Thalaivirithan Margabandu Balakrishnan 
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
,
Snigdha Yanamadala
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
,
Jaganmohan Janardhanam
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
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Abstract

Background Gluteus maximus, by virtue of its continued adjunct contraction with the anal sphincter, has many characteristics and histomorphological features mimicking type I musculature. Hence, anal sphincter replacement therapy with gluteus maximus has all avenues for lasting successful results. This study aimed to evaluate the efficiency of unstimulated gluteus maximus sphincteroplasty for anal incontinence reconstruction and neosphincter reconstruction in perineal colostomy cases.

Methods From March 2015 to March 2020, the records of patients who underwent gluteus maximus sphincteroplasty for fecal incontinence were analyzed in this retrospective cohort study. The mean age was 31.55 years. Eleven patients (females = 4, males = 7) underwent anal incontinence reconstruction. All these cases were followed up for an average period of 28.46 months.

Results Good continence was observed in all patients with an average Cleveland Clinic Florida Faecal Incontinence Score of 3.18 (p = 0.0035). At the end of the follow-up period, the average median resting pressure found via manometry was 44.64 mm Hg, and the average median squeeze pressure was 103.55mm Hg. The mean of the average continence contraction time at the end of the follow-up period was found to be 3.64 minutes. None of our patients had complete continence failure. None of our patients used perineal pads or made any lifestyle alterations at the end of the follow-up period. Most of the patients expressed satisfactory continence.

Conclusion Despite being untrained with implantable electrodes, the gluteus maximus muscle produced very good continence results with our way of construct. In addition, with its good lumen occluding effect, it achieves good resting and squeeze anal pressure around the anal canal/bowel with trivial reeducation. Hence, it has become our institution's procedure of choice for anal sphincter reconstruction.

Keywords

sphincteroplasty - anal incontinence - gluteus maximus sphincteroplasty


Publikationsverlauf

Artikel online veröffentlicht:
30. Dezember 2022

© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Merchea A, Larson DW. Anus. In: Townsend CM, Evers BM, Beauchamp RD, Mattox KL. eds. Sabiston Textbook of Surgery. 20th ed.. Canada: Elsevier; 2016: 1395-1395
    Google Scholar
  • 2 Whitehead WE, Wald A, Norton NJ. Treatment options for fecal incontinence. Dis Colon Rectum 2001; 44 (01) 131-142 , discussion 142–144
    CrossrefPubMedGoogle Scholar
  • 3 Madoff RD, Rosen HR, Baeten CG. et al. Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial. Gastroenterology 1999; 116 (03) 549-556
    CrossrefPubMedGoogle Scholar
  • 4 Standring S. Ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40th edition. Spain: Churchill Livingstone; 2008
    Google Scholar
  • 5 Taylor GI, Gianoutsos MP, Morris SF. The neurovascular territories of the skin and muscles: anatomic study and clinical implications. Plast Reconstr Surg 1994; 94 (01) 1-36
    CrossrefPubMedGoogle Scholar
  • 6 Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36 (01) 77-97
    CrossrefPubMedGoogle Scholar
  • 7 Chetwood CH. Plastic operations for restoration of sphincter ani, with report of a case. Med Rec 1902; 61 (14) 529 https://www.proquest.com/openview/d690fa99f1f772a6c95f7287ded9a09b/1?pq-origsite=gscholar&cbl=40146 Accessed May 18, 2022
    Google Scholar
  • 8 Pickrell KL, Broadbent TR, Masters FW, Metzger JT. Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle; a report of four cases in children. Ann Surg 1952; 135 (06) 853-862
    CrossrefPubMedGoogle Scholar
  • 9 Hofmann-von Kap-herr S, Koltai IL, Tennant LJ. Anal sphincter substitute using autologous smooth muscle in a fold-over, half-cylinder, double plasty (SMFD-plasty): a new method of treatment of anorectal incontinence. J Pediatr Surg 1985; 20 (02) 134-137
    CrossrefPubMedGoogle Scholar
  • 10 Bruining HA, Bos KE, Colthoff EG, Tolhurst DE. Creation of an anal sphincter mechanism by bilateral proximally based gluteal muscle transposition. Plast Reconstr Surg 1981; 67 (01) 70-73
    CrossrefPubMedGoogle Scholar
  • 11 Guelinckx PJ, Sinsel NK, Gruwez JA. Anal sphincter reconstruction with the gluteus maximus muscle: anatomic and physiologic considerations concerning conventional and dynamic gluteoplasty. Plast Reconstr Surg 1996; 98 (02) 293-302 , discussion 303–304
    CrossrefPubMedGoogle Scholar
  • 12 Baeten C, Spaans F, Fluks A. An implanted neuromuscular stimulator for fecal continence following previously implanted gracilis muscle. Report of a case. Dis Colon Rectum 1988; 31 (02) 134-137
    CrossrefPubMedGoogle Scholar
  • 13 Baeten CG, Konsten J, Spaans F. et al. Dynamic graciloplasty for treatment of faecal incontinence. Lancet 1991; 338 (8776): 1163-1165
    CrossrefPubMedGoogle Scholar
  • 14 Corman ML. Gracilis muscle transposition for anal incontinence: late results. Br J Surg 1985; 72 (Suppl): S21-S22
    CrossrefPubMedGoogle Scholar
  • 15 Ben-Hur N, Gilai A, Golan J, Sagher U, Issac M. Reconstruction of the anal sphincter by gracilis muscle transfer: the value of electromyography in the preoperative assessment and postoperative management of the patient. Br J Plast Surg 1980; 33 (02) 156-160
    CrossrefPubMedGoogle Scholar
  • 16 Leguit Jr P, van Baal JG, Brummelkamp WH. Gracilis muscle transposition in the treatment of fecal incontinence. Long-term follow-up and evaluation of anal pressure recordings. Dis Colon Rectum 1985; 28 (01) 1-4
    CrossrefPubMedGoogle Scholar
  • 17 Wee JT, Wong CS. Functional anal sphincter reconstruction with the gracilis muscle after abdominoperineal resection. Lancet 1983; 2 (8361): 1245-1246
    CrossrefPubMedGoogle Scholar
  • 18 Hentz VR. Construction of a rectal sphincter using the origin of the gluteus maximus muscle. Plast Reconstr Surg 1982; 70 (01) 82-85
    CrossrefPubMedGoogle Scholar
  • 19 Prochiantz A, Gross P. Gluteal myoplasty for sphincter replacement: principles, results and prospects. J Pediatr Surg 1982; 17 (01) 25-30
    CrossrefPubMedGoogle Scholar
  • 20 Devesa JM, Vicente E, Enríquez JM. et al. Total fecal incontinence–a new method of gluteus maximus transposition: preliminary results and report of previous experience with similar procedures. Dis Colon Rectum 1992; 35 (04) 339-349
    CrossrefPubMedGoogle Scholar
  • 21 Orgel MG, Kucan JO. A double-split gluteus maximus muscle flap for reconstruction of the rectal sphincter. Plast Reconstr Surg 1985; 75 (01) 62-67
    CrossrefPubMedGoogle Scholar
  • 22 Hultman CS, Zenn MR, Agarwal T, Baker CC. Restoration of fecal continence after functional gluteoplasty: long-term results, technical refinements, and donor-site morbidity. Ann Plast Surg 2006; 56 (01) 65-70 , discussion 70–71
    CrossrefPubMedGoogle Scholar
  • 23 Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981; 67 (02) 177-187
    CrossrefPubMedGoogle Scholar
  • 24 Chandra A, Mishra B, Kumar S. et al. Composite antropyloric valve and gluteus maximus muscle wrap for neoanal reconstruction: initial results. Dis Colon Rectum 2019; 62 (01) 104-111
    CrossrefPubMedGoogle Scholar