Levator ani as substitute puborectalis sling in treatment of anal incontinence

For anal incontinence caused by destroyed or absent sphincter mechanism, a levator sling serving as a substitute puborectalis sling was used in five patients with incontinence of varied causes with good to excellent results. This sling was constructed bu freeing the insertion of the pubococcygeus and the ileococcygeus muscles from the coccyx. By further freeing the arcus tendineus from the lateral wall of the pelvis, the sling is made to arise from the pubis, thus theoretically giving the sling the potential of greater traction.