Gluteus maximus transplant, levator ani repair

Transplantation of gluteus maximus and levator ani muscle for surgical treatment of anal incontinence. Anal incontinence is a phenomenon in which feces are out of control through the anus or the ability to control is weakened. There are many causes of anal incontinence, and the degree of incontinence is very different. Anal incontinence can be either habitual or due to the development of congenital nervous system deficiency, more common in the lumbosacral spina bifida or meningocele. The feeling of defecation and the movement of muscles of these patients are affected. When the rectum is filled, there is no intention, so there is no reflexive defecation activity. The anal external sphincter system and the pelvic floor muscles are relaxed under the absence of motor nerves, so the feces can leak out at any time. Anal incontinence can also be seen in cases of rectal anal trauma, but it is most common in postoperative anorectal malformation, especially in high anal atresia, rectal hypoplasia, blind end located above the levator ani muscle, lack of anal internal sphincter, external sphincter development A number of changes have taken place. External and external sphincter injuries, postoperative complications and scar formation may affect the function of the external sphincter. In addition, the failure of the rectum to pass through the muscle complex during rectal prolapse is also one of the causes of postoperative incontinence. According to our statistics, 70.1% of anal incontinence is secondary to high postoperative anal surgery, anal incontinence is also seen in anal diseases, such as anal rectal prolapse leading to sphincter relaxation, tendon or anal canal tumor traction, anal scar stenosis, etc. . Because the cause of anal incontinence and the degree of incontinence are very different, sometimes caused by several reasons at the same time, the treatment is quite complicated. Curing disease: Indication 1. Anal incontinence secondary to rectal anal atresia or rectal anal trauma. 2, a variety of neurogenic anal incontinence. Contraindications Anal stricture incontinence, excessive scar around the anus, excessive anal caliber and a large number of rectal mucosa valgus are not suitable for this operation. Surgical procedure 1. Incision: Make an arc-shaped incision between the tip of the tailbone and the anus. 2. After the subcutaneous tissue is released, the levator ani muscle and the external anal sphincter are exposed, and the posterior wall of the rectum is exposed. The investigation confirmed that the levator ani muscle was too weak, or the injury was too large during the initial operation, and could not be sutured to the midline. The sputum separates the adipose tissue from both sides, exposing the medial part of the gluteus maximus, and depending on the extent of the levator ani muscle defect in the rectum, determines the width of the gluteus maximus flap. On the side of the gluteus maximus, an arcuate incision is made from the tailbone to the outside and below, and the gluteus maximus flap is about 1 cm thick. A corresponding arc-shaped incision is made on the surface of the contralateral gluteus maximus to release the contralateral gluteus maximus of the same thickness. 3. Pull the muscle flaps on the left and right sides toward the midline, cover the back of the rectum, and suture or overlap the sutures with 2-0 silk. At the same time, the index finger can be placed in the rectum, and when the sutured muscle flap is actually pushed forward to the rectum, it is appropriate to increase the rectal angle. The free lower edge of the muscle flap is sutured to the residual external sphincter and levator ani muscle at the distal end of the rectum. The wound was drained with a rubber sheet and the incision was sutured layer by layer.