Anal spinchter reconstruction. Surgical results and functional outcome.

Direct repair of anal sphincter injuries was undertaken in seven patients, three men and four women. Obstetrical tears were the cause of injury in all the female patients; surgical trauma, road traffic accident, and sexual assault caused the injuries to the men. Temporary covering colostomies were fashioned for six patients either before, or at the time of, the repair. There were no major complications associated either with the repairs or with the colostomy closures. The degree of incontinence was reduced in all patients, but only two became completely continent after the operation. The change in anal sphincter pressures was not significant. Postanal repair was subsequently undertaken for one woman, but all the other patients were satisfied with their repairs. We conclude that direct sphincter repair should be the treatment of choice for patients with major injury to the anal sphinchter.