Results of surgery in idiopathic faecal incontinence

The surgical treatment of idiopathic faecal incontinence remains a difficult problem particularly in those cases where advanced neuropathy is present. The physiological basis for the post-anal repair have 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 need to be assessed in a long term experiment and in a prospective randomised comparison with conventional post-anal repair. Gracilis transposition in idiopathic faecal incontinence has shown very disappointing results and has probably no role in the treatment of this condition. Intestinal stoma in very advanced cases may occasionally provide important hygienic and psychological benefit.