ABSTRACT
The anal encirclement procedure, as originally described by Thiersh in 1891, was initially designed for treatment of rectal procidentia. This procedure has been adopted for the treatment of selected patients with anal incontinence. This procedure is not indicated in patients who have a mechanical defect of the sphincter that can be surgically corrected. The patient is given a complete mechanical, as well as antibiotic, bowel preparation. The patient is also given a single dose of a second-generation cephalosporin just prior to the procedure. Due to the limited indications for this procedure, there are no large studies of its use for fecal incontinence. Anal encirclement has a limited use in the treatment of anal incontinence. However, with severe incontinence secondary to a neurogenic sphincter or a mechanically disrupted sphincter which cannot be repaired, it offers the potential for significant improvement in these patients who might otherwise be considered a candidate for a colostomy.
