Overlapping anal sphincter repair for faecal incontinence due to sphincter trauma: five year follow-up functional results

  • E. E. Londono-Schimmer
  • R. Garcia-Duperly
  • R. J. Nicholls
  • J. K. Ritchie
  • P. R. Hawley
  • J. P. S. Thomson
Original Articles


Disruption of the anal sphincter results from obstetric injury, ano-rectal operations or external trauma. Obstetric or surgical division of the sphincteric mechanism may not be immediately apparent and the clinical presentation of incontinence may occur several years later [1, 2]. Reconstruction of the sphincter using a fascial sling or direct end-to-end repair of the disrupted sphincter result in a high failure rate. Failure after direct end-to-end repair is usually caused by break down of the suture line owing to retraction of the muscle ends [3]. Parks advocated an overlapping repair [4] in which the disrupted ends of the sphincter were mobilised and wrapped around each other. This paper reports the results of overlapping sphincter repair for faecal incontinence resulting from trauma, after a 5 year follow-up period.


Public Health Internal Medicine Functional Result Failure Rate Faecal Incontinence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Une rupture de l'anneau sphinctérien anal peut résulter de lésions obstétricales, de séquelles d'interventions chirurgicales et de lésions traumatiques. Les ruptures obstétricales ou chirurgicales du sphincter peuvent ne pas être immédiatement apparentes et le développement clinique de l'incontinence peut survenir plusieurs années après la lésion. La reconstruction du sphincter avec un lambeau de fascia ou la réparation directe bord à bord du sphincter rompu se soldent par un taux élevé d'échecs. L'échec après suture bord à bord est dû à la desunion de la suture en raison d'une rétraction des extrémités musculaires. Parks avait recommandé une suture en gilet dans laquelle les deux extrémités du sphincter rompu sont mobilisées et suturées après chevauchement. Cet article rapporte le follow-up à 5 ans de ruptures sphinctériennes d'origine traumatique traitées par chevauchement des extrémités sphinctériennes.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Motson RW, McPartlin JF, Browning GG (1983) Anal sphincter injury. Ann R Coll Surg Engl [Suppl]: 33–35Google Scholar
  2. 2.
    Elliot MS, Hancke E, Henry MM, et al (1987) Faecal incontinence. Symposium. Int J Colorectal Dis 2:173–186Google Scholar
  3. 3.
    Motson RW (1985) Sphincter injuries: indications for, and results of sphincter repair. Br J Surg 72 [Suppl]:S19-S21Google Scholar
  4. 4.
    Parks AG, McPartlin JF (1971) Late repair of injuries of the anal sphincter. Proc R Soc Med 64:1187–1189Google Scholar
  5. 5.
    Browning GGP, Parks AG (1983) Postanal repair for neuropathic faecal incontinence: correlation of clinical result and anal canal pressures. Br J Surg 70:101–104Google Scholar
  6. 6.
    Phillips RKS (1992) Faecal incontinence: Treatment: anal sphincter repair. In: Henry MM, Swash M (eds) Coloproctology and the pelvic floor: pathophysiology and management. 2nd Edn. Butterworths-Heinemann, Oxford, pp 260–264Google Scholar
  7. 7.
    Fang DT, Nivatvongs S, Vermeulen FD, et al (1984) Overlapping sphincteroplasty for acquired anal incontinence. Dis Colon Rectum 27:720–722Google Scholar
  8. 8.
    Pezim ME, Spencer RJ, Stanhope R, et al (1987) Sphincter repair for fecal incontinence after obstetrical or iatrogenic injury. Dis Colon Rectum 30:521–525Google Scholar
  9. 9.
    Rudd WWH, Sullivan ES, Corman ML et al (1982) Anal incontinence (symposium). Dis Colon Rectum 25:90–107Google Scholar
  10. 10.
    Cherry DA, Greenwald ML (1992) Anal incontinence. In: Beck DE, Wexner SD (eds) Fundamentals of anorectal surgery. McGraw Hill, New York, pp 104–130Google Scholar
  11. 11.
    Jorge JMN, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97Google Scholar
  12. 12.
    Mandelstam DA (1985) Faecal incontinence. A. Social and economic factors. In: Henry MM, Swash M (eds) Coloproctology and the pelvic floor: pathophysiology and management. Butterworths, London, pp 217–222Google Scholar
  13. 13.
    Enck P, Bielefeldt K, Rathamann W, Purrmann J, Tschope D, Erckenbrecht JF (1991) Epidemiology of fecal incontinence in selected patient groups. Int J Colorectal Dis 6:143–146Google Scholar
  14. 14.
    Venkatesh KS, Ramanujan PS, Larson DM, Haywood MA (1989) Anorectal complications of vaginal deliveries. Dis Colon Rectum 32:1039–1041Google Scholar
  15. 15.
    Scott ADN, Hawley PR, Phillips RKS (1989) Results of external sphincter repair in Crohn's disease. Br J Surg 76:959–960Google Scholar
  16. 16.
    Browning GGP, Motson RW (1984) Anal sphincter injury: management and results of Park's sphincter repair. Ann Surg 199:351–357Google Scholar
  17. 17.
    Keighley MRB, Fielding FWL (1983) Management of faecal incontinence and results of surgical treatment. Br J Surg 70:463–468Google Scholar
  18. 18.
    Wexner SD, Marchetti F, Jagelman DG (1991) The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review. Dis Colon Rectum 34:22–30Google Scholar
  19. 19.
    Fleshman JW, Peters WR, Shemesh EI, Fry RD, Kodner IJ (1991) Anal sphincter reconstruction: anterior overlapping muscle repair. Dis Colon Rectum 34:739–743Google Scholar
  20. 20.
    Fleshman JW, Dreznick Z, Fry RD, Kodner IJ (1991) Anal sphincter repair for obstetric injury: manometric evaluation of functional results. Dis Colon Rectum 34:1061–1067Google Scholar
  21. 21.
    Lauberg S, Swash M, Henry MM (1988) Delayed external sphincter repair for obstetric tear. Br J Surg 75:786–788Google Scholar
  22. 22.
    Lauberg S, Swash M, Henry MM (1990) Effect of postanal repair on progress of neurogenic damage to the pelvic floor. Br J Surg 77:519–522Google Scholar
  23. 23.
    Snooks SJ, Swash M, Mathers SE, Henry MM (1990) Effect of vaginal delivery on the pelvic floor: a 5 year follow-up. Br J Surg 77:1358–1360Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • E. E. Londono-Schimmer
    • 1
  • R. Garcia-Duperly
    • 1
  • R. J. Nicholls
    • 1
  • J. K. Ritchie
    • 1
  • P. R. Hawley
    • 1
  • J. P. S. Thomson
    • 1
  1. 1.St. Mark's HospitalLondonUK

Personalised recommendations