Abstract
<title>Abstract</title> <p>Introduction: Irreversible traumatic war injuries to the anal sphincter led to fecal incontinence (FI), "requiring a stoma", which has a significant negative impact on a patient’s well-being. This study evaluates the outcomes and durability of unilateral gluteoplasty with/ without adjuvant surgical techniques, to manage end-stage fecal incontinence. Methods: Prospectively, from November 2009 and January 2024, 56 male patients, with traumatic fecal incontinence, were managed by unilateral gluteoplasty. We add anal column plication, smooth muscle-plasty, and pectinatoplasty to restore neo-anal cushions, improve resting anal pressure and reduce soiling. All patients scored preoperatively, 3, 6, 12, and 24 months postoperatively. Results: All patients were male with a mean age of 22 years. 50% of patients had already undergone emergency operations and colostomy post penetrating war injuries with complete anal sphincter destruction and fecal incontinence. 78.6% were significantly improved post unilateral gluteoplasty, allowing for colostomy closure. Their estimated manometric studies and functional scores improved significantly. Others remained incontinent due to sensory incontinence despite excellent voluntary sphincter tone. Resting anal pressure improved dramatically post anal column plication, smooth muscle-plasty, and pectinatoplasty. Conclusion: Components of normal anal continence include sensory, reservoir components, and motor squeeze. Therefore, no perfect replacement for a normal anal sphincter. Gluteoplasty, a skeletal muscle wrap, alone is sufficient to restore the squeeze component. But it is not enough to maintain normal resting anal pressure. Patients with sensory incontinence are unlikely to benefit from it. The presence of a sensory reservoir and a skin-lined anal canal (pectin) also, appear to be important in addressing fecal incontinence.</p>