Anal sphincteroplasty and gracilis muscle transposition using transvaginal access in a patient with fecal incontinence

Abstract

We performed anal sphincteroplasty and gracilis muscle transposition operation using transvaginal access in a 32-year-old woman who with incontinence to solid stool after obstetric trauma (Fig. 1a). Rectal ultrasonography revealed a 25 % defect of the internal anal sphincter and a 40 % defect of the external anal sphincter ventrally. Surgery was performed in lithotomy position. The anal canal was mobilized circumferentially through and in the posterior vaginal wall (Fig. 2a, b). Repair of internal and external sphincters with No 0 vicryl U-sutures was performed (Fig. 3a). The gracilis muscle was isolated and transposed to sublevator level via a subcutaneous tunnel (Fig. 3b). Anal canal was surrounded by gracilis muscle (Fig. 4a, b) which was sutured to itself with No 0 vicryl U-sutures, to subcutaneous external anal sphincter and ischial tuberosity bilaterally (Fig. 5). Vaginal and femoral incisions were closed after leaving a drain in the sublevator region (Fig. 1b). Postoperative course was uneventful. Pelvic MR imaging obtained at the third week postoperatively showed right gracilis muscle flap, surrounding the anal canal (Fig. 6a, b). The patient was followed up for 3 months and is fully continent to gas, liquids and solids.

Is the Ischioanal Fossa the Most Appropriate Surgical Area for Fecal Incontinence Surgery?

“…1 Combined anterior anal sphincteroplasty and adynamic gracilis muscle transposition operation using transvaginal access to in a female patient suffered from FI depending to anal sphincter damages was published by our group, and three more operations were performed by using same method with success in last 24 months. 2 All patients have adequate continence to gas, solid and liquid stool in their postoperative periods.…”