Sphincter repair for fecal incontinence.

Twenty-seven patients who had sphincter repair by one surgeon over the last ten years were reviewed. Previous surgery, childbirth, and perineal trauma were the most common causes. Twelve patients had been treated previously using an anal continence device (N = 6), postanal repair (N = 5), and rectopexy (N = 1). A covering colostomy was used in ten patients. At the initial operation only 7 patients were rendered completely continent, 13 others were improved, but results were poor in the other 7. Four of the 7 patients were rendered completely continent after secondary operations. Maximum anal pressure and maximum squeeze pressure did not change significantly after surgery; however, preoperative maximum squeeze pressure in patients who achieved complete continence was significantly greater than in those that did not. Poor results usually were associated with severe obstetric trauma.