الفهرس 
Epidemiology, Importance and Clinical relevanceOnly 14 pages are availabe for public view
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Abstract
Adynamic unilateral gluteoplasty is considered one of the last options for managing patients with end-stage faecal incontinence in whom every other therapy has failed. The patients must be selected critically and be informed extensively preoperatively about potential problems in order to achieve satisfactory results. The aim of this study is to evaluate the efficacy of unilateral gluteus maximus flap transposition around the anal canal whether distally based or proximally based flap in restoration of anal function and its effect on the quality of life in patients with end stage anal incontinence to whom the only remaining treatment option was permanent colostomy, especially after abdominoperineal resection. This prospective study included 20 patients with end stage fecal incontinence. It was conducted between April 2005 and April 2007 in Colorectal Surgery Unit, Mansoura University Hospital. All patients were referred to colorectal unit suffering from end stage fecal incontinence according to Mansoura Clinical Scoring System (MCSS) of anal incontinence. The patients included were 16 males and 4 females with an age ranging from 7 to 31 (mean 15.8 ± 7.29) years. Patients were subjected to restoration of anorectal function, based on the technique of the operation; all patients were divided into 2 groups: Group I: Included 10 patients who had subjected to distally based gluteus maximus flap for end stage fecal incontinence. Group II: Included 10 patients who had subjected to proximal based gluteus maximus flap for end stage fecal incontinence. We believe that the nonstimulated unilateral gluteus maximus neosphincter is a viable alternative to the stimulated graciloplasty and the artificial bowel sphincter in the management of end-stage fecal incontinence, because the gluteus maximus is an accessory muscle of continence, patients learn to use it quite easy, and could achieve full continence. In other wards, patients can use the gluteus neosphincter voluntarily to help them get to the toilet without soiling. So, it is considered as one of the best alternatives of treatment of anal incontinence and its results are still reasonably good and satisfactory to many patients in spite of not providing involuntary full continence. On the other hand, we recommend the proximally based gluteoplasty rather than the distally based type as it seems to be a simple, easy to carry out as the neurovascular bundle is far from the dissection of the flap from its insertion at the iliotibial tract and that leading to adequate length of the muscle flap without tension for wrapping around the anal canal.