Surgical management of anorectal incontinence due to internal anal sphincter deficiency

Br J Surg. 1997 Feb;84(2):226-30.


Background: The aetiology, surgical management and outcome in 15 patients with anorectal incontinence due to internal and sphincter (IAS) deficiency as a result of previous anal surgery (n = 14) or penetrating trauma (n = 1) was studied.

Methods: The degree of anorectal incontinence was scored by the Cleveland Clinic system; median score was 14 (range 11-16) before surgery. In all patients the anal sphincter mechanism was assessed by endoanal ultrasonography. Thirteen of the 15 patients underwent either rotation (n = 5), island (n = 5) or advancement (n = 3) anoplasty to correct the contour defect in the anal canal. In the remaining two patients direct IAS repair was performed.

Results: Four of the 13 patients who underwent anoplasty developed wound breakdown as the result of infection (n = 3) or inadvertent suture removal (n = 1). A defunctioning stoma was required in three of these patients but all of these have been closed. At median follow-up of 34 (range 6-72) months, all patients who underwent anoplasty have normal defaecatory control and a median continence score of 2 (range 0-4). Direct IAS repair produced no symptomatic improvement in either patient.

Conclusion: These results suggest that anoplasty deserves further evaluation in the treatment of anorectal incontinence due to discrete IAS defects, but that the place of IAS repair remains uncertain.

MeSH terms

  • Adult
  • Aged
  • Anal Canal / diagnostic imaging
  • Anal Canal / injuries*
  • Anus Diseases / complications
  • Anus Diseases / surgery*
  • Cicatrix
  • Fecal Incontinence / diagnostic imaging
  • Fecal Incontinence / etiology
  • Fecal Incontinence / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / etiology*
  • Surgical Flaps
  • Treatment Outcome
  • Ultrasonography
  • Wound Healing
  • Wounds, Penetrating / complications*