Overlapping sphincteroplasty for acquired anal incontinence

When defects of the anal sphincter are caused by trauma, surgical correction can be successful even in long-standing cases. At the University of Minnesota, we used overlapping sphincteroplasty in 79 patients with fecal incontinence from 1952 to 1982. There were 62 women and 17 men. Ages ranged from 17 to 68 years. Incontinence had been present from three weeks to 40 years and had been caused by childbirth, previous anorectal surgery, trauma or rectal prolapse. Following overlapping sphincteroplasty, there was one postoperative death and 13 complications. Complications included temporary difficulty in voiding, excessive bleeding, abscess formation, fecal impaction, and hematoma. Seventy-six of the 78 surviving patients were followed for an average of 35 months. Results ranged from excellent to poor with only one failure. From our experience it was concluded that several factors were important for good surgical results. 1) The patient must have intact neuromuscular bundle with detectable voluntary sphincter contraction. 2) If a primary repair has failed, a minimum duration of three months should elapse before overlapping sphincteroplasty is attempted. 3) Scar tissue from the severed muscles should not be excised. 4) The internal and external sphincter muscles should not be separated. 5) A temporary concomitant colostomy is not necessary.