Sphincteroplasty for Traumatic Anal Sphincter Insufficiency

Yamana Tetsuo

doi:10.3862/jcoloproctology.68.961

Sphincteroplasty is one option for the treatment of traumatic anal sphincter dysfunction for those complaining of fecal incontinence. The most common cause is a third-degree perineal tear during childbirth. Anal surgeries such as fistulotomy for complicated anal fistulas or lateral sphincterotomy for anal fissures are also possible causes. Among these, childbirth injury is the most consistent indicator for sphincteroplasty. Anal ultrasound is usually performed to evaluate a sphincter defect preoperatively. The overlapping method is more utilized than direct methods. Scar tissue is dissected and transected, and both ends are overlapped and sutured. Additionally, the author prefers to add perineal body reconstruction to strengthen the repair. Preoperative mechanical bowel preparation and postoperative diet restriction are not necessary, so early hospital discharge is possible. Symptoms of fecal incontinence improve by more than 50% on the Wexner score. Likewise, physiological parameters, including maximum squeeze pressure levels, are significantly higher. Unfortunately, continence outcomes may be found to deteriorate with long-term follow-up.

Sphincteroplasty for Traumatic Anal Sphincter Insufficiency

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