症例は80歳の女性．50年前の出産で会陰裂傷の縫合不全が放置され，軟便とガスの失禁および頻回の尿路感染を主訴に当科を受診した．会陰部の肛門と膣の間に皮膚の介在がなく総排泄腔様変形となっており，陳旧性会陰裂傷による括約筋不全の診断で手術を施行した．瘢痕化した直腸肛門と膣壁を分離し，外括約筋断端を同定し周囲を剥離した．左右に分かれた会陰体を正中で縫合し，括約筋修復術を行った．次に膣壁断端を自然に寄ったところで縫合し，肛門と膣の間に十分な距離が保てるように皮弁を形成して閉創した．手術後はWexner scoreおよびFISIスコアの著明な改善を認め，尿路感染を起こすことなく経過している．

Faecal incontinence is a debilitating chronic clinical condition which may affect the patient and care givers. Modality of treatment is based on severity of the symptoms as well as the anatomical defect itself, availability of resources and expertise. We describe a modified technique of dynamic graciloplasty as neoanal sphincter for the treatment severe faecal incontinence who has failed previo...

Successful eradication of a complicated, recurrent fistula-in-ano with maintenance of anal continence, requires a specialized surgical approach. Mucosal advancement anoplasty is associated with acceptably low rates of recurrence and continence and is reported in this small series of 11 patients where it followed preliminary deployment of a loose guiding and drainage seton. The technique was als...