Fecal incontinence caused by overt anterior sphincter defects sustained during childbirth is usually treated by a delayed overlapping repair of the external anal sphincter. However, an obstetric trauma is frequently associated with disruption of the perineal body and loss of the distal rectovaginal septum. Data regarding a combined repair, consisting of restoration of the rectovaginal septum and perineal body, overlapping external anal sphincter repair, and imbrication of the internal anal sphincter, are scanty. PURPOSE: This prospective study was aimed at the following: 1) evaluating the clinical outcome of such an anterior anal repair in patients with fecal incontinence caused by obstetric trauma; 2) comparing the functional results with those obtained in a historical group of patients who underwent a conventional direct sphincter repair. METHODS: During the period between 1973 and 1989, 24 female patients (median age, 44 (range, 28- 67) years) with fecal incontinence underwent direct sphincter repair (Group I). During the period between 1989 and 1994, a consecutive series of 31 female patients (median age, 46 (range, 23-78) years) with fecal incontinence underwent anterior anal repair (Group II). RESULTS: At two years of follow- up, continence had been restored in 15 patients (63 percent) in Group I, whereas restoration of continence was successful in 21 patients (68 percent) in Group II. CONCLUSION: The more complex anterior anal repair fails to confer clinical benefit compared with the rather simple direct sphincter repair.

Anterior anal repair, Direct sphincter repair, Fecal incontinence, Obstetric trauma
dx.doi.org/10.1007/BF02238250, hdl.handle.net/1765/69417
Diseases of the Colon and Rectum
Department of Surgery

Briel, J.W, de Boer, L.M, Hop, W.C.J, & Schouten, W.R. (1998). Clinical outcome of anterior overlapping external anal sphincter repair with internal anal sphincter imbrication. Diseases of the Colon and Rectum, 41(2), 209–214. doi:10.1007/BF02238250