GLUTEUS MAXIMUS TRANSPLANTATION FOR FECAL INCONTINENCE AFTER SURGERY OF HIGH ANALATRESIA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

KONG Feiteng ¹ , LI Fuyu ¹ , LIU Juxian ² , CHEN Yongmei ¹ , WU Yang ¹ , YANG Xiaodong ¹ , XIANG Bo. ¹

1Department of Pediatric Surgery, 2Department of Ultrasonography, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.;

Corresponding author：

Keywords：

Gluteus maximus, Anal sphincter ,High anal atresia ,Fecal incontinence

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Objective To investigate the application of gluteus maximus transplantation for fecal incontinence after surgery of high anal atresia. Methods Between December 2002 and November 2010, 25 patients with fecal incontinence were treated with gluteus maximus transplantation, which was caused by surgery of high anal atresia. There were 11 males
and 14 females with an average age of 10.2 years (range, 3-22 years). Preoperative radiography, anorectal manometer, and electromyogram showed abnormality or deficiency of anal sphincter function. Wexner score, Fecal Incontinence Quality of Life (FIQL) questionnaire, and Self-rated Health Measurement Scale Version 1.0 (SRHMS) score were used to evaluate l ife qual ity of the patients. The anorectal manometer, intra-rectal ultrasound examination, and defecation radiography were performed. Results Healing of incision by first intention was achieved in 23 cases and rectal-wound fistula occurred in 2 cases. The follow-up time was 1 to 9 years (mean, 6.3 years). Defecation frequency was decreased from more than 10 times to 4-6 times every day. Wexner score and SRHMS were significantly improved at 1 or 2 years after surgery when compared with preoperative socres (P lt; 0.05). FIQL was also significantly improved after 2 years (P lt; 0.05). At 2 years after surgery, the anal maximum systol ic pressure, contraction duration, and maximum systol ic volume were improved, showing significant differences when compared with those at preoperation and 1 year after surgery (P lt; 0.05). Conclusion Gluteus maximus transplantation can improve defecation controls in the patients with fecal incontinence after surgery of high anal atresia.

Citation： KONG Feiteng,LI Fuyu,LIU Juxian,CHEN Yongmei,WU Yang,YANG Xiaodong,XIANG Bo.. GLUTEUS MAXIMUS TRANSPLANTATION FOR FECAL INCONTINENCE AFTER SURGERY OF HIGH ANALATRESIA. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(5): 571-575. doi: Copy

1.	Peña A. Surgical management of anorectal malformations: a unified concept. Pediatr Surg Int, 1988, 3(2-3): 82-93.
2.	Hamid CH, Holland AJ, Martin HC. Long-term outcome of anorectal malformations: the patient perspective. Pediatr Surg Int, 2007, 23(2): 97-102.
3.	Aliev EA. Surgical treatment of anal sphincter insufficiency using the flaps of the gluteus maximus muscle. Klin Khir, 2010, (6): 46-49.
4.	Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1): 77-97.
5.	Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum, 2000, 43(1): 9-16.
6.	许军, 王斌会, 胡敏燕, 等. 自测健康评定量表的研制与考评. 中国行为医学科学, 2000, 9(1): 65-68.
7.	Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology, 2006, 130(5): 1527-1537.
8.	白玉作, 王维林, 王慧贞, 等. 小儿肛门直肠畸形术后远期生活质量的初步研究. 中华小儿外科杂志, 1999, 20(5): 263-266.
9.	Hartman EE, Qort FJ, Aronson DC, et al. Quality of life and disease-specific functioning of patients with anorectal malformations or Hirschsprung’s disease: a review. Arch Dis Child, 2011, 96(4): 398-406.
10.	Rajindrajith S, Devanarayana NM, Benninga MA. Constipation-associated and nonretentive fecal incontinence in children and adolescents: an epidemiological survey in Sri Lanka. J Pediatr Gastroenterol Nutr, 2010, 51(4): 472-476.
11.	Grasshoff-Derr S, Backhaus K, Hubert D, et al. A successful treatment strategy in infants and adolescents with anorectal malformation and incontinence with combined hydrocolonic ultrasound and bowel management. Pediatr Surg Int, 2011, 27(10): 1099-1103.
12.	Danielson J, Karlbom U, Graf W, et al. Long-term outcome after free autogenous muscle transplantation for anal incontinence in children with anorectal malformations. J Pediatr Surg, 2010, 45(10): 2036-2040.
13.	Shafik A, Olfat El Sibai, Shafik AA, et al. Contraction of gluteal maximus muscle on increase of intra-abdominal pressure: role in the fecal continence mechanism. Surg Innov, 2007, 14(4): 270-274.
14.	陈姬, 李福玉, 刘利君, 等. 儿童臀大肌下部肌瓣转位重建肛门外括约肌的应用解剖. 解剖与临床, 2007, 12(4): 243-245, 249.
15.	Cera SM, Wexner SD. Muscle transposition: does it still have a role? Clin Colon Rectal Surg, 2005, 18(1): 46-54.
16.	张震, 吴晔明. 先天性肛门直肠畸形术后排便功能评估标准. 临床小儿外科杂志, 2008, 7(4): 52-54, 63.
17.	Hancock BD, Smith K. The internal sphincter and Lord’s procedure for haemorrhoids. Br J Surg, 1975, 62(10): 833-836.

1. Peña A. Surgical management of anorectal malformations: a unified concept. Pediatr Surg Int, 1988, 3(2-3): 82-93.
2. Hamid CH, Holland AJ, Martin HC. Long-term outcome of anorectal malformations: the patient perspective. Pediatr Surg Int, 2007, 23(2): 97-102.
3. Aliev EA. Surgical treatment of anal sphincter insufficiency using the flaps of the gluteus maximus muscle. Klin Khir, 2010, (6): 46-49.
4. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1): 77-97.
5. Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum, 2000, 43(1): 9-16.
6. 许军, 王斌会, 胡敏燕, 等. 自测健康评定量表的研制与考评. 中国行为医学科学, 2000, 9(1): 65-68.
7. Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology, 2006, 130(5): 1527-1537.
8. 白玉作, 王维林, 王慧贞, 等. 小儿肛门直肠畸形术后远期生活质量的初步研究. 中华小儿外科杂志, 1999, 20(5): 263-266.
9. Hartman EE, Qort FJ, Aronson DC, et al. Quality of life and disease-specific functioning of patients with anorectal malformations or Hirschsprung’s disease: a review. Arch Dis Child, 2011, 96(4): 398-406.
10. Rajindrajith S, Devanarayana NM, Benninga MA. Constipation-associated and nonretentive fecal incontinence in children and adolescents: an epidemiological survey in Sri Lanka. J Pediatr Gastroenterol Nutr, 2010, 51(4): 472-476.
11. Grasshoff-Derr S, Backhaus K, Hubert D, et al. A successful treatment strategy in infants and adolescents with anorectal malformation and incontinence with combined hydrocolonic ultrasound and bowel management. Pediatr Surg Int, 2011, 27(10): 1099-1103.
12. Danielson J, Karlbom U, Graf W, et al. Long-term outcome after free autogenous muscle transplantation for anal incontinence in children with anorectal malformations. J Pediatr Surg, 2010, 45(10): 2036-2040.
13. Shafik A, Olfat El Sibai, Shafik AA, et al. Contraction of gluteal maximus muscle on increase of intra-abdominal pressure: role in the fecal continence mechanism. Surg Innov, 2007, 14(4): 270-274.
14. 陈姬, 李福玉, 刘利君, 等. 儿童臀大肌下部肌瓣转位重建肛门外括约肌的应用解剖. 解剖与临床, 2007, 12(4): 243-245, 249.
15. Cera SM, Wexner SD. Muscle transposition: does it still have a role? Clin Colon Rectal Surg, 2005, 18(1): 46-54.
16. 张震, 吴晔明. 先天性肛门直肠畸形术后排便功能评估标准. 临床小儿外科杂志, 2008, 7(4): 52-54, 63.
17. Hancock BD, Smith K. The internal sphincter and Lord’s procedure for haemorrhoids. Br J Surg, 1975, 62(10): 833-836.

Chinese Journal of Reparative and Reconstructive Surgery

GLUTEUS MAXIMUS TRANSPLANTATION FOR FECAL INCONTINENCE AFTER SURGERY OF HIGH ANALATRESIA

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