Technique of Anal Sphincter Repair (Syn. Overlap Technique)

Abstract

The commonest injury to the sphincter complex is obstetric [3]; by disruption at traumatic (forceps) delivery, tearing, or by misplaced episiotomy. If not recognised by the attending obstetrician and properly and promptly repaired, the wound will heal by secondary intention. This will result in a deficient anal canal with poor function. The young patient, however, may withstand serious disruption of the external anal sphincter if the puborectalis muscle remains intact, frequently accepting poor control of flatus and faecal soiling as a required sacrifice to the Gods for safe vaginal delivery of her baby. Subsequent childbirth may further stretch the pelvic floor and puborectalis muscles, and the patient may then present with socially unacceptable faecal incontinence (although only too frequently she tries to conceal her “shame”). Development of faecal incontinence may be delayed on other cases until middle age when the pelvic floor muscles naturally begin to deteriorate [2]. This deterioration is accelerated in those patients who are habitual strainers. A few patients present as a result of trauma, either from vehicles or missiles: these patients always have extra tissue damage and scarring, especially after high-velocity injury or explosions.