Modified technique of bilateral gluteus maximus transposition for reconstruction of sphincter for pediatric traumatic fecal incontinence.

ABSTRACT

PURPOSE: The aim of the study was to report our 13-year experience of 14 children with gluteus maximus muscular transposition to treat post-trauma fecal incontinence and discuss our technical modifications to this surgical procedure. METHODS: Fourteen children (median age 9.9years) with complete fecal incontinence after traumas received this procedure from December 1998 to February 2011. The major modification of the surgery was that we transposed two thick muscular bundles about 2cm in diameter bilaterally. They surrounded the middle portion of rectum to act as sphincters. We used dynamic defecography and anorectal endosonography to observe the functions of the transposed muscles. Wexner scores, fecal incontinence quality of life questionnaire and self-rated health measurement scale scores had been used to evaluate their life quality. RESULTS: The median follow-up time was 6.3years. Twelve children reported prominently improved fecal controls with reduced stool frequency. Postoperative dynamic defecography and anorectal endosongraphy vividly demonstrated the satisfactory voluntary contractile and relaxed states of the reconstructed muscle. Wexner scores were significantly improved both 1year and 2years after the procedure (P<.05). Two year after surgery, rectal maximum systolic pressure, contraction duration and maximum systolic volume significantly increased compared with the results before and 1year after surgery (P<.05) CONCLUSIONS: This modified technique of bilateral gluteus maximus transposition for reconstruction of sphincter efficiently improved fecal control and life quality for pediatric patients with traumatic fecal incontinence.