Sphincter repair and postanal repair

Abstract

Several factors are responsible for continence, and treatment options vary. We distinguish between morphological defects of the sphincter mechanism and functional incontinence disorders. Possible candidates for sphincter repair should have a clinical and physiological workup. If a distinct defect is localized, sphincter repair can be done either as a direct repair or as an overlapping sphincteroplasty. No protective stoma is needed. For idiopathic fecal incontinence, the method of postanal repair has been described. Short-term results for overlapping sphincter repair (< 5 years) are successful in about 75% of patients. In the long run (>10 years), the success rate decreases significantly. Success rates for postanal repair are in the range of about 20-30%. Despite poor long-term results, sphincteroplasty is the best surgical treatment option for isolated, preferably anterior sphincter defects. Physiological tests are useful for planning an operation. At present, postanal repair is not a first-line treatment in idiopathic fecal incontinence. © 2010 Springer-Verlag Milan.