Invited Commentary

  • Steven D. Wexner


Dr Pfeifer has clearly and expertly outlined the methods, techniques, results, and morbidity of sphincter repair and postanal repair in Chapter 28. Although the initial reported success rates with sphincter repair were in excess of 90%, several long-term studies have revealed those success rates are in the vicinity of 15% to 30% [1, 2, 3, 4]. There are certain factors that may be predictive of failure, including pudendal neuropathy. However, prior sphincter repair does not appear to auger for failure of subsequent sphincter repair [5]. Because of the unfortunately poor long-term efficacy of this operation, it is certainly not a panacea. Current debate centers around whether the anal sphincters should be repaired, as, although the procedure may improve incontinence, it may also induce significant scarring. If scarring is produced and the result is suboptimal, then subsequent procedures such as stimulated graciloplasty, artificial bowel sphincter, and even sacral nerve stimulation may not be as successful.


Fecal Incontinence Cleveland Clinic Sacral Nerve Stimulation Sphincter Defect Sphincter Repair 


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Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • Steven D. Wexner
    • 1
  1. 1.Division of Colon and Rectal SurgeryCleveland Clinic FloridaWestonUSA

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