ABSTRACT

Objective:

To describe the anatomic fecal continence mechanism, the mechanism of action, the complex trauma itself and the reconstructive principles and to present the evidence-based results in a large scale study of a comprehensive approach to the repair of complex sphincter ani rupture.

Materials and Methods:

A total of 1,014 women with sphincter ani rupture were operated by a personal operation technique exactly in the opposite order of the trauma, first the internal sphincter, then the external sphincter in end-to-end fashion and lastly the perineal body with meticulous attention to detail.

Results:

At first attempt the sphincter ani rupture had healed in 924 patients (91%) and at final attempt 988 patients (98%) had healed with incontinence in 10 and a failure was noted in 26 patients out of whom 10 were inoperable.

Conclusion:

This operation technique is highly effective since the normal functional anatomy is reconstructed and restored along with the physiology. It can be recommended to the low-, middle- and high-income world as evidence-based standard.