Gluteus Maximus Transposition



Gluteus Maximus Transposition


Jason W. Allen

Herand Abcarian





Preoperative Planning

In patients being considered for gluteus maximus transposition, preoperative evaluation should begin with the standard examinations for all patients with fecal incontinence. All patients should undergo anorectal physiologic studies including anal manometry, electromyography, and pudendal nerve terminal motor latency. Electromyography of the gluteus maximus is also necessary and endoanal ultrasonography is useful in documenting the degree of sphincter defects. Defecography assists in assessing pelvic floor dysfunction. Although evaluation of the entire patient should be undertaken according to screening guidelines, a fecal incontinence score should be obtained to allow postoperative objective documentation of any improvement.

All patients receive a mechanical bowel preparation along with oral antibiotics. Patients receive second- or third-generation antibiotics at the induction of anesthesia. This procedure may be done under regional or general anesthesia. A ureteral catheter is inserted after which the patient is positioned in the prone jackknife position with the buttocks taped laterally to allow for exposure. We do not perform a diverting ostomy as part of our procedure as diversion has not been shown to decrease the wound infection rate.


Surgery


Technique


Dissection and Mobilization of the Gluteus Maximus Muscle

Two mirror image incisions are made on both buttocks that run parallel to the caudal portion of the gluteus maximus muscle on each side (Fig. 29.1). A lateral circumanal incision
is made bilaterally for tunneling the bifurcated ends of the opposing slings (Fig. 29.2

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Jun 12, 2016 | Posted by in GENERAL | Comments Off on Gluteus Maximus Transposition
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