ABSTRACT
Patients best suited for surgical correction of fecal incontinence are those in whom incontinence is secondary to an anterior defect. Obstetric and iatrogenic trauma are among the most common causes of surgically correctable fecal incontinence. Prior to surgery, patients are given a full mechanical and oral antibiotic bowel preparation. After induction of general anesthesia, an in-dwelling bladder catheter is inserted, and the patient is placed in the prone jackknife position on a pelvic roll. Parenteral broad-spectrum antibiotics are administered on-call to the operating room. The anterior dissection is best performed with the surgeon’s contralateral index finger in the vagina. This is useful to gauge tissue thickness in what is generally a densely scarred anovaginal and rectovaginal septum. Complete pre- and postoperative physiologic data will be required to justify a worldwide change in the standard surgical approach to anterior sphincter injuries.
