BILATERAL GLUTEUS MAXIMUS TRANSPOSITION FOR ANAL INCONTINENCE

Seven patients (five women and two men) with;anal incontinence in whom previous surgery had failed, were treated by bilateral gluteus maximu s transposition. All patients were incontinent to solid stool. Previou s surgery was postanal repair in four women and secondary overlapping suture for obstetric tear in one. The two men were treated in childhoo d for anal atresia. No covering stoma was used. Wound infection occurr ed in three patients, requiring surgical drainage in two. After follow up of more than 1 year three patients experienced improved continence but in four continence was unchanged. Anorectal physiology studies sho wed moderately increased resting and squeeze pressures in patients who were improved by the operation, but none could retain more than 200 m l of viscous fluid instilled into the rectum. No change in rectal sens itivity or volume tolerance was found. This preliminary series does no t indicate that better results are obtained by gluteus maximus transpo sition than by unstimulated graciloplasty.