[Effects of different gracilis loops in graciloplasty on XXXX ].

@entity1 @entity1241 @entity322 @entity600
OBJECTIVE: To compare the clinical effect of graciloplasty using two different gracilis encircled loops and to research the better method for the treatment of @entity1241 after anoplasty for imperforate anus. METHODS: Clinical data of 38 @entity322 @entity1 with @entity600 undergoing graciloplasty in our hospitals from January 2009 to January 2012 were retrospectively analyzed. Twenty @entity1 received the modified surgery in which the gracilis muscle was transposed anticlockwise into a circum-anal tunnel with a U-loop and its tendon secured to the ipsilateral pectineal ligament. Eighteen @entity1 received the traditional surgery in which the gracilis muscle was wrapped clockwise around the anus with a y-loop and its tendon secured to the contralateral periosteum of ischial tuberosity or pectineal ligament. All the @entity1 were evaluated via Wexner score and anal manometry before surgery and 2 weeks, 6 months, 1 year and 2 years after surgery. In addition, it was assessed whether the @entity1 had difficulty defecating while squatting after surgery. RESULTS: Generalized estimating equations showed that the Wexner score in two groups gradually decreased after surgery(P=0.000), but there was no significant difference between two groups(P=0.554). At 2 weeks, 6 months, 1 year and 2 years after surgery, there were respectively 4 cases(20.0%), 3 cases(15.0%), 2 cases(10.0%), 1 case(5.0%), who showed squatting difficult defecation in the U-loop group, and 10 cases(55.6%), 12 cases(66.7%), 10 cases(55.6%), 8 cases(44.4%) in the y-loop group. The probability of squatting difficult defecation in U-loop group was significantly lower compared to y-loop group(P=0.002), but the probability of squatting difficult defecation in two groups did not obviously change with time(P=0.057). Repeated measures ANOVA showed that anal resting pressure, anal maximal squeeze pressure, duration of anal squeeze, and rectal maximum tolerable volume in two groups were gradually improved after surgery (all P<0.01), but there were no significant differences between two groups(all P>0.05). CONCLUSIONS: Graciloplasty with different gracilis loops can improve anal function. However, U-loop can better improve difficult defecating while squatting, and is worthwhile for spreading in clinical practice.
