Smooth muscle reverse plasty. A new method to treat anorectal incontinence in infants with high anal and rectal atresia. Results after gracilis plasty and free muscle transplantation.

Forty-one patients with Pickrell's gracilis transposition, 6 patients with free muscle transplantations using the Hakelius/Grotte's method, and 2 children with a smooth muscle transplantation after the method described by Schmidt are reported. The results are compared with those reported in the literature. A new operative method is described that can be carried out during infancy at the same time as the abdominal perineal pull-through operation. It involves the fashioning of a smooth muscle cuff formed from a segment of pulled-through colon that is denuded from its mucosa. This cuff is folded back over the distal end of the pulled-through colon. The radiological and manometric results in 2 infants operated upon by this method are described.