Anal Sphincteroplasty: Operative Management for Fecal Incontinence

Keywords: Anorectal, Sphincteroplasty, Incontinence

Background and Conclusions: Background: Fecal incontinence is a common and costly problem in the United States. The incidence in the adult population is 8.3%. Numerous procedures have been developed to treat incontinence with varying degrees of success. These include sphincter repair, neosphincter formation, colostomy, and sacral nerve stimulator placement.

Summary: A 73-year-old man with a history of Parkinson’s disease sustained a rectal trauma requiring surgical debridement. He developed fecal incontinence. An evaluation including endorectal ultrasound was performed. The patient was found to have a defect of the internal and external sphincter muscles. He was brought to the operating room for an anal sphincteroplasty. A pena muscle stimulator probe was used to identify viable muscle. The sphincteroplasty was performed without any peri-operative complications. His incontinence improved after surgery. His symptoms decreased from daily to weekly episodes. Although he remained symptomatic, his quality of life significantly improved. He was eventually brought to the operating room for placement of a sacral nerve stimulator. His symptoms continued to improve with placement of this device.

Conclusions: Anal sphincteroplasty is an important technique in the treatment of fecal incontinence. For example, in the setting of obstetrical injury, this operation remains an important tool for colorectal surgeons. In patients with large sphincter defects, overlapping sphincteroplasty can significantly decrease the symptoms of fecal incontinence. However, many patients will either remain symptomatic after surgery or develop recurrent symptoms over time. A sacral nerve stimulator can be used adjunctively with sphincter repair to treat incontinence effectively in a select group of patients.