Gluteus Maximus Flap Transplantation For Anrectal Dysfunction After Anorectal Malformation Operation:Clinical Observation Of40Cases

Objective:Congenital anorectal malformation (CAM) was one of the most common digestive disorders,which treatment was various types of Anoplasty,some patienis with CAM continued to suffer from postoperative anal dysfunctions, which seriously impacted on the quality of the children’s life. To report a series of cases of gluteus maximus flap transplantation to reinforce levator ani for the anorectal dysfunction after anorectal malformation operation.To sum up the results of the clinical and imaging,in order to further the knowledge of this pathology, its therapy and prognosis, and to improve the patient’s quality of life.Methods:40patients presented with the anorectal dysfunction after anorectal malformation operation were assessed prospectively,including the diseases histories and physical examines.All the subjects were received the following examinatons,including pelvic floor MR、Barium enema、pelvic floor electromyography、segmented intestine test、anusrectum pressure、clinical appraise for incontinence and balloon extract experiment before the operation.Except for anal stenosis, abnormal position of the anus, rectal distension and gluteus maximus dysfunction, gluteus maximus function was good and levator ani muscle dysfunction were selected.All the children suffered from bowel dysfunction due to levator ani muscle dysfunction and afterward underwent gluteus maximus flap transplantation to reinforce levator ani.Clinic presentation、segmented intestine test、anusrectum pressure、clinical appraise for incontinence、pelvic floor MR and balloon extract experiment were compared before and after the operation, in order to objectively evaluated the surgical treatment.Results:1.Common material:all40patients,25males,15females(male/female=1.67/1), operation ages ranged from4years to14years(mean age8.51years).The follow-up time ranged from3months to60months (mean time30months).20patients presented with history of colostomy、4patients with history of expansion of intestinal resection and10patients with history of anoplasty.2. Test results:Pelvic floor electromyography showed that gluteus maximus was good. Pelvic floor MR and pelvic floor electromyography revealed that all the children levator ani was poor and14patients sphincter ani externus was bad.40cases were divided into two groups and all subjects were scored poor before operations.Group(Ⅰ)26subjects with levator ani muscle dysfunction,24patients were followed up after the operation.10were scored excellent and14good, the excellent and good rates were100%. Group(Ⅱ)14subjects with both levator ani muscle and anal sphincter disfunction,12patients were followed up,none were scored excellent,4good and8poor, the excellent and good rates were50%.All the excellent and good rates were77.78%. Anusrectum pressure showed no change after the treatment.3.Clinic presentation:Before the surgery:All children fecal pollution every day,mostly dry and the number of bowel movements was3-5times/day. Rectal examination:a lot of dry defecation could be touched in the rectal. Feces moved up and down in the anal canal, but can not be discharged.Group(Ⅰ)3months later,24patients’anrectal function gradually improved,the bowel movements gradually reduced,2to5times/day. Group(Ⅱ)3months after the surgery,the bowel movements more than6times/day. All the children the stool in the rectum were reduced,6months anrectal function gradually improved, more than2years after surgery could get a good bowel function. 4. Statistic analysis:The result of anusrectum pressure used the mean±standard deviation.The prognosis of R*C analysis for the variance between the two groups.The results of t-test and X2-test for change after the treatment with significant difference(P<0.05).Conclusions:1. Gluteus maximus function was good and levator ani muscle dysfunction were selected.All the children suffered from bowel dysfunction due to levator ani muscle dysfunction and afterward underwent gluteus maximus flap transplantation to reinforce levator ani,whom could achieve satisfactory results.2. The surgery was simple and safe, easy to master, and could achieve good benefits, especially suitable to promotional application.