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. 2022 Dec 30;56(1):22-30.
doi: 10.1055/s-0042-1759499. eCollection 2023 Feb.

Unstimulated Gluteus Maximus Sphincteroplasty for Bowel Incontinence

Thalaivirithan Margabandu Balakrishnan  1 , Snigdha Yanamadala  1 , Jaganmohan Janardhanam  1
Affiliations

Unstimulated Gluteus Maximus Sphincteroplasty for Bowel Incontinence

Thalaivirithan Margabandu Balakrishnan et al. Indian J Plast Surg. .

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: anal incontinence; gluteus maximus sphincteroplasty; sphincteroplasty.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Illustration of case 1. ( A ) Anal incontinence with patulous anus. ( B ) Preoperative markings. ( C ) Coronal magnetic resonance imaging with an absence of definition of the native anal sphincter (red arrows). ( D ). Intraoperative marking for lower third gluteus maximus. ( E ) Skeletonization of neurovascular pedicle.
Fig. 2
Fig. 2
Illustration of case 1. ( A ) Complete dissection of the lower third of gluteus maximus. ( B ) Splitting of the lower third of gluteus maximus. ( C ) Transposition through the perianal tunnel and final inset. ( D ) Final suture line.
Fig. 3
Fig. 3
High-resolution transanorectal ultrasound showing gluteus maximus sphincter in case 1.
Fig. 4
Fig. 4
Preoperative picture of case 2 showing patulous anal canal.
Fig. 5
Fig. 5
Axial magnetic resonance imaging of case 2 (at the level of upper Ischial tuberosity) showing a patulous anal canal with no definition of the native sphincter.
Fig. 6
Fig. 6
Illustration of case 2. ( A ) Preoperative marking for bilateral lower third gluteus maximus muscle harvest. ( B ) Harvest in progress. ( C ) Lower third muscle being split.
Fig. 7
Fig. 7
Illustration of case 2. ( A ) Bilateral muscle transposition and inset. ( B ) Final suture line. ( C ) 35 months follow-up picture. ( D ) 35 months follow-up manometric anal squeeze pressure reading of 112 mm Hg.
Fig. 8
Fig. 8
Illustration of case 3. ( A ) Scarred perineum, perineal colostomy, and contracting gluteus maximus. ( B ) Right parasagittal magnetic resonance imaging is showing severely scarred pelvis.
Fig. 9
Fig. 9
Illustration of case 3. ( A ). Preoperative picture. ( B ). Preoperative marking. ( C ) Splitting of lower one-third of muscle. ( D ) Final suture line after transposition.
Fig. 10
Fig. 10
Illustration of case 3. ( A ). 20 months later postoperative picture—posterior view. ( B ) 20 months later postoperative picture—anterior view.
Fig. 11
Fig. 11
Magnetic resonance imaging axial section at the ischium level reveals good mass of gluteus sphincter in case 3.
Fig. 12
Fig. 12
Case 3; high-resolution anal manometric report at 20 months after surgery.
See this image and copyright information in PMC

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