The use of unilateral gluteus maximus muscle for the management of fecal incontinence following anorectal surgery

A dynamic unilateral gluteoplasty sutured as a U-shaped sling around the anal canal was carried out in 9 patients with fecal incontinence, including 8 males and one female ranging in age from 6 to 46 years (mean, 13.9 years). All had previous anorectal surgery: in four cases a Swenson's operation for congenital megacolon, in 2 cases a pull-through procedure for high anorectal anomalies, in 2 cases for a failed sphincteric repair, and in one case to correct rectal prolapse. Morbidity was limited to minor wound infection and postoperative dermatitis (4 cases). Seven patients achieved an improvement in their continence score. Overall continence score was 5–6 (mean, 4.0; SD = 1.4) preoperatively and 2–6 (mean, 4.0; SD = 1.4) postoperatively, a difference which was statistically significant (p = 0.006). Maximum resting pressure and maximum squeeze pressure were improved. None of the patients could retain 200 ml saline in their rectum preoperatively, while 6 patients could do so postoperatively. Rectoanal inhibitory reflex was positive in 2 patients preoperatively and in 6 postoperatively. In conclusion, unilateral dynamic gluteoplasty is an effective option for improving continence with no mortality and minimal morbidity in patients who previously had anorectal surgery, reserving the other gluteus muscle for use in a second attempt if first operation fails. Received: 22 September 1999 / Accepted in revised form: 10 October 1999