Results of surgery in idiopathic faecal incontinence

The surgical treatment of idiopathic faecal incontinence remains a difficult problem, particularly in cases where advanced neuropathy is present. The physiological basis for the post-anal repair has now been questioned and the long-term functional results seem to be rather unsatisfactory. Pelvic floor repair is a more comprehensive approach with encouraging initial results, which have now been shown in a prospective randomised trial to be superior to those of conventional post-anal repair. Gracilis transposition in idiopathic faecal incontinence has shown very disappointing results and probably has no role in the treatment of this condition. In very advanced cases intestinal stoma may occasionally provide important hygienic and psychological benefits.