Combined anal sphincteroplasty and perineal reconstruction for fecal incontinence in women.

CONTEXT Although success rates are limited, anal sphincteroplasty is commonly used to treat women with fecal incontinence. OBJECTIVES To investigate the long-term efficacy of a novel surgical procedure-sphincteroplasty with perineal reconstruction-for the management of fecal incontinence. METHODS The current prospective study comprised women presenting to the Division of Urogynecology and Reconstructive Pelvic Surgery at Riverside Methodist Hospital in Columbus, Ohio, with fecal incontinence and anterior external anal sphincter disruption. Endoanal ultrasonography was used in the presurgical evaluation of anal sphincters. Sphincteroplasty was completed in an end-to-end manner and perineoplasty in a standardized fashion. RESULTS Twenty women participated in the present study. Four patients (20%) had prior surgery (sphincteroplasty or rectocele repair) for fecal incontinence. Before surgery, 15 patients (75%) were incontinent of solid stool, and all 20 patients had incontinence of liquid stool and flatus. The mean number of incontinence episodes was 3 per week (range, 1-8 per week). At 3-year postsurgical follow-up, all 20 patients were continent of solid stool, 18 (90%) were continent of liquid stool, and 10 (50%) were continent of flatus. CONCLUSION Based on the results of this pilot study, anal sphincteroplasty with modified perineoplasty appears to have acceptable long-term results for the treatment of women with fecal incontinence and anatomic anal sphincter defects.