대한대장항문학회

Anal incontinence following pelvic trauma, surgery or neurologic disorder has<br>significant medical and social implications. When no known functioning sphincter<br>muscles are present, surgical correction of this distressing condition other than by<br>stomal fecal diversion is aimed at recreating a sphincter mechanism under voluntary<br>control.<br>The use of the gluteus maximus encircling the neorectum with a contractile muscualr<br>ring provides an active control of continence and reserves the anorectal angulation.<br>The sacrifice of the entire gluteus maximum muscle in an ambulatory patient will<br>cause difficulty in climbing stairs; however, the use of the anatomically dissected lower<br>half will preserve its function. With careful dissection, the lower half of the g1uteus<br>maximus muscle together with its neurovascular supply can be developed for anal<br>sphincter reconstruction. Three Patient, (two men and one woman) underwent g1uteus<br>maximus transposition for complete anal incontinence. The indication for operation were<br>sphincter destruction secondary to extensive soft tissue necrosis on perianal, perineal and<br>buttock area due to necrotizing fascitis(n=2), and soft tissue defect on perianal, buttock<br>area due to trauma(n=1). The procedure is performed with the use of a diverting<br>colostomy. The inferior portion of the origin of each gluteus maximus is detached from<br>the sacrum and coccyx, bifurcated,and tunneled subcutaneously to encircle the anus. The<br>ends were sutured together to form two opposing slings of voluntary muscles.<br>Postoperatively two patient regained continence to solid stool, one to liquid stool as<br>well.<br>The technique of constructing sphincter is simple and utilizes principles of muscle<br>tendon transfer without jeopardizing function of gait. Furthermore the gluteus maximus<br>muscle, being an accessory muscle of anal continence, is an ideal structure for this<br>reconstruction.<br>