Pickrell graciloplasty for fecal incontinence complicating anal malperforation: a video vignette

Excerpt

Patients with congenital imperforate anus who have not been fully treated in childhood are rare. The methods of surgical management of anal incontinence are variable but when sphincter repair, sacral neuromodulation, and implantation of an artificial sphincter are not possible, dynamic or non-dynamic graciloplasty appears to be the sole remedy. Here we present the case of a 41-year-old patient with severe fecal incontinence (Wexner score 18/20) with history out imperforate anus who had been re-implanted at birth. Anal manometry found a complete absence of contraction. Endoanal ultrasound found only a few scattered, discontinuous sphincter fibers around the circumference of the anal canal. Because of this severe fecal incontinence therapeutic alternative, a non-dynamic graciloplasty [[1]] was proposed to the patient. The technique is shown in the attached video. …