The role of sphincter repair for fecal incontinence

Abstract

In patients with a sphincter defect, sphincter repair was more commonly utilized as the main surgical option before sacral neuromodulation (SNM) became available. A sphincter repair, when used alone for management of fecal incontinence, is associated with deterioration in function over time. The goal of this chapter is to discuss the role of performing sphincter repair in select patients. We will discuss recommendations, technique, and limitations of the procedure. Currently, indications for performing a sphincter repair can include post obstetrical sphincter injury, repair of a rectovaginal fistula (RVF), and treatment of fecal incontinence when sacral nerve stimulator (SNS) is not available or contraindicated. Goal of repair is correction of anatomic defect, however there are factors that can affect longevity of repair and correlation to function. Care of patients with fecal incontinence should be viewed as a chronic disease and a combination of several treatments (both medical and surgical) may be required to provide the best result for a patient in the long-term. It is also important to set expectations for outcomes and consider predictors of repair durability when choosing a treatment modality that will provide the best possible outcome for the patient. Adjustments in the treatment approach may be required throughout the patient’s lifetime.