Results of the modified Hartl gracilis plasty.

Follow-up results of patients who had a gracilis plasty for incontinence after rectal atresia showed that in 8 of 11 patients there was marked improvement. 6 children had good continence and 3 sufficient continence. Similar results have been reported by others and are encouraging. The high percentage of infected wounds did not seem to influence the results. The results in operations for incontinence with myelomeningoceles were different. Only 5 times was there sufficient continence and in only 2 patients was subjective improvement recorded. It must be pointed out that the function of the gracilis muscle was tested preoperatively by electromyographic examination. These unsatisfactory results can undoubtedly also be achieved with conservative therapy. Incontinence with myelomeningoceles is therefore no indication for a gracilis plasty. These varying results appear to indicate that success can only be obtained with a gracilis plasty if there are still functioning parts of the pelvic musculature present and if parts of the anorectum are able to mature. If this is true, then there is a direct connection between the results we obtained and those achieved by free muscle transplantation or transposition of a denervated muscle. No doubt, the gracilis plasty is not the only available method to achieve continence, but it will often improve the function of the sphincter in patients with incontinence following rectal atresia operations.