Technique of Anal Sphincter Repair (Syn. Overlap Technique)

  • Charles V. Mann
  • Richard E. Glass


The commonest injury to the sphincter complex is obstetric [3]; by disruption at traumatic (forceps) delivery, tearing, or by misplaced episiotomy. If not recognised by the attending obstetrician and properly and promptly repaired, the wound will heal by secondary intention. This will result in a deficient anal canal with poor function. The young patient, however, may withstand serious disruption of the external anal sphincter if the puborectalis muscle remains intact, frequently accepting poor control of flatus and faecal soiling as a required sacrifice to the Gods for safe vaginal delivery of her baby. Subsequent childbirth may further stretch the pelvic floor and puborectalis muscles, and the patient may then present with socially unacceptable faecal incontinence (although only too frequently she tries to conceal her “shame”). Development of faecal incontinence may be delayed on other cases until middle age when the pelvic floor muscles naturally begin to deteriorate [2]. This deterioration is accelerated in those patients who are habitual strainers. A few patients present as a result of trauma, either from vehicles or missiles: these patients always have extra tissue damage and scarring, especially after high-velocity injury or explosions.


Faecal Incontinence Anal Sphincter Pelvic Floor Muscle External Anal Sphincter Anal Incontinence 
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References and Further Reading

  1. 1.
    Blaisdell PC (1940) Repair of the incontinent sphincter ani. Surg Gynecol Obstet 70: 692Google Scholar
  2. 2.
    Browning GCP, Motson RW (1983) Results of Parks’ operation for faecal incontinence after anal injury. Br Med J 286: 1873CrossRefGoogle Scholar
  3. 3.
    Corman ML (1985) Anal incontinence following obstetrical injury. Dis Colon Rectum 28: 86PubMedCrossRefGoogle Scholar
  4. 4.
    Corman ML (1989) Colon and rectal surgery, 2nd edn. Lippincott, Philadelphia, pp 186–187Google Scholar
  5. 5.
    Fang DT, Nivatvongs S, Vermuelen FD et al. (1984) Overlapping sphincteroplasty for acquired anal incontinence. Dis Colon Rectum 27: 720PubMedCrossRefGoogle Scholar
  6. 6.
    Goldberg SM, Gordon PP, Nivatvongs S (1980) Essentials of ano-rectal surgery. Lippincott, PhiladelphiaGoogle Scholar
  7. 7.
    Marti MC, Givel JC (1989) Surgery of ano-rectal diseases. Springer, Heidelberg and New York, Chap. 22Google Scholar
  8. 8.
    Motson RW (1985) Sphincter injuries: indications for, and results of sphincter repair. Br J Surg 72 (Suppl): 19–21CrossRefGoogle Scholar
  9. 9.
    Parks AG, McPartin JF (1971) Late repairs of the anal sphincter. Proc R Soc Med 64: 1187PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1997

Authors and Affiliations

  • Charles V. Mann
    • 1
    • 2
  • Richard E. Glass
    • 3
  1. 1.Northwick Park and St Marks Hospital TrustHarrowUK
  2. 2.The Royal London Hospital TrustLondonUK
  3. 3.Princess Margaret HospitalSwindonUK

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