Author/Authors :
Farid, Mohamed Faculty of Medicine - Mansoura University Hospital - Colorectal Surgery Unit, Egypt , Ghazy, Hosam Faculty of Medicine - Mansoura University Hospital - Department of Surgery, Egypt , Abd Monem, Hesham Faculty of Medicine - Mansoura University Hospital - Colorectal Surgery Unit, Egypt , Omar, Waleed Faculty of Medicine - Mansoura University Hospital - Colorectal Surgery Unit, Egypt , EINakeeb, Ayman Faculty of Medicine - Mansoura University Hospital - Department of Surgery, Egypt , Abo elkheir, Mohamed Faculty of Medicine - Mansoura University Hospital - Colorectal Surgery Unit, Egypt , Fekry, Amir Faculty of Medicine - Mansoura University Hospital - Department of Surgery, Egypt , Badr, Sabery Faculty of Medicine - Mansoura University Hospital - Department of Surgery, Egypt , Awady, Saleh Faculty of Medicine - Mansoura University Hospital - Department of Surgery, Egypt , Youssef, Tamer Faculty of Medicine - Mansoura University Hospital - Department of Surgery, Egypt , Khafagy, Wael Faculty of Medicine - Mansoura University Hospital - Colorectal Surgery Unit, Egypt , Magdy, Alaa Faculty of Medicine - Mansoura University Hospital - Department of Surgery, Egypt , El Ghazaly, Mohamed Faculty of Medicine - Mansoura University Hospital - Department of Surgery, 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 HI) 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
