Advances in the surgical management of anal incontinence.

Standard procedures for anal incontinence due to trauma (obstetric lesions, iatrogenic lesions in connection with anal surgery) have been overlapping suture of the external anal sphincter and, for idiopathic incontinence, postnatal repair according to Parks. In cases where these operations fail, or if a pronounced sphincter destruction is found, transposition of striated muscles (primarily the gracilis and the gluteus maximus) may be performed. In patients where the incontinence is due to a primary neurological disease, implantation of an artificial sphincter or a neurostimulator may be the only alternatives. The technique and the results of these newer operations for anal incontinence are presented.