PROXIMALLY BASED VERSUS DISTALLY BASED GLUTEUS MUSCLE FLAP IN TREATMENT OF END STAGE FECAL INCONTINENCE

Document Type : Original Article

Authors

1 Colorectal Surgery Unit, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt

2 Department of Surgery, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt

Abstract

Aim: To compare proximally based versus distally based gluteus maximus muscle flap transposition in patients with end 
stage fecal incontinence. 
Methods: Between August 2005 and August 2007, this prospective randomized study was performed on twenty patients with an end stage anal incontinence. They were sixteen men and four women with an age ranging from 7 to 31 years. A proximally based gluteus maximus flap (group III) was carried out in ten patients while, a distally based flap (group I ) was done in the other ten. Patients were followed up for 6 – 18 months both subjectively and objectively with evaluation of their incontinence score, anorectal manometry, saline enema test and magnetic resonance imaging (MRI). 
Results: Overall, 6/10 patients (60%) in group I and 8/10 patients (80%) in group II were clinically improved with down 
staging of their incontinence scores from C3 to 0 (P 0.003 & 0.0001 respectively). 
This was confirmed by the significant changes in anorectal manometry and saline enema test. MRI done one month 
postoperatively showed disruption in three patients. 
Conclusion: Proximally based gluteoplasty appears to be an excellent encirclement procedure that restores voluntary squeeze pressure as well as rectal sensation when compared with unilateral distally based gluteoplasty.

Keywords

The Egyptian Journal of Surgery
Volume 27, Issue 4
October 2008
Pages 200-207

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