Overlapping sphincteroplasty for acquired anal incontinence

Overlapping sphincter repair is the operation of choice for incontinence due to obstetric injuries, trauma, or previous anorectal surgery. We present our experience from 1981 to 1990 using the overlapping sphincter repair for anal incontinence resulting from childbirth in 21 patients (58%), previous anorectal surgery in 7 (19%), trauma in 1 (3%), gynecologic surgery in 1 (3%), multifactorial causes in 1 (3%); the incontinence was idiopathic in 5 (14%). All 36 patients were operated on by one surgeon and had identical care. There were no deaths. Two patients required colostomy for wound sepsis. Two additional patients (with idiopathic incontinence) elected to have a colostomy after failure of sphincter repair. Long-term follow-up was possible in 33 patients (92%). Twenty-four patients (73%) were considered to have good to excellent results. Eliminating those patients with idiopathic anal incontinence improved the results significantly. Twenty-two patients (85%) reported good to excellent results. Twenty-four patients (92%) consider their continence better now than before surgery and 25 patients (96%) would undergo the procedure again. In conclusion, overlapping sphincteroplasty has a definite role in treatment of anal incontinence due to obstetric injury, anorectal surgery, and trauma, but a more limited role in treatment of idiopathic anal incontinence.