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Less invasive technique of taking of the gluteus maximus muscle for graciloplasty

M. Valla, JS. Valla, H. Steyaert, M. Juricic, J. Lauron

Lenval Foundation, Nice, France

 

ABSTRACT

Aim: In case of fecal incontinence, the use of the gluteus maximus muscle for sphincteroplasty is a traditional procedure. The conventional surgery uses 3 or 4 incisions on the thigh in order to take muscle. The goal of this technique is to reduce to these incisions to only 2.

Technique: The technique is illustrated by a 3 minutes video. Two incisions are made, a proximal one in the upper 1/3 of the thigh, a distal one located on the internal face of the knee. A laparoscopic optic with an operating channel (27cm length 11mm diameter) is introduced successively through these incisions. After CO ² insufflation in the muscular compartment, the muscle is liberated under visual monitoring by dissection, section and monopolar coagulation. The lower insertion is divided and the muscle is extracted through the higher incision taking care to preserve its vasculo-nervous pedicle. The perianal transposition is then carried out according to the traditional technique.

Materials, Results: This technique was successfully used in two male teenagers having anal incontinence after surgery for high anorectal malformation.

Conclusion: This technique permitted us to reduce the cutaneous incisions and to avoid a blind finger dissection of the gluteus maximus muscle.

 

Key words: fecal incontinence, sphincteroplasty,