This type of repair is typically performed for woman with a defect in their anal sphincter, as a result of an obstetric injury due to a difficult vaginal delivery, in which a 3rd or 4th degree tear was sustained. Although repair is usually performed at the time of initial injury, a defect can still result in incontinence, and require subsequent repair.
The anterior overlapping sphincter repair aims to excise the scar from previous injury and tighten the anal sphincter by overlapping and suturing anal sphincter at the front (anterior) of the anus. The pelvic floor (levator muscle) is also tightened (levatoplasty) at the same procedure. The skin is then closed leaving a small defect to allow ongoing drainage.
A normal diet is commenced immediately post-operatively with no benefit shown in prolonged fasting .
- Nessin A, Wexner SD, Agachan F et al. Is bowel confinement necessary after anorectal reconstructive surgery? A prospective randomized surgeon trial. Dis Colon Rectum 1999; 42:16-23.