Adult fecal incontinence due to anal sphincter lesions, which preoperative evaluation? which surgical approach?

Management of fecal incontinence due to anal sphincter lesions involves a good preoperative evalution. This tends to confirm the incontinence, to search its mechanism, and to classify it according to the type of sphincter lesion owing to manometry, ultasonography, and defecography. The surgical option is discussed after failure of medical treatment and biofeedback. The aim of surgery is to restore the incontinence and to maintain the exemption function. The surgical procedures include the sphincter repairs, the sphincter substitution, or even colostomy. Among the procedures of sphincter repairs, the direct repair is performed for obstetrical ruptures or postsurgical lesions of the anal sphincter, and the pelvic floor repairs are performed for fecal incontinence with intact but poorly functionning sphincter. Failures of these conservative methods lead the surgeons to develop new techniques for anal sphincter substitution. Dynamic graciloplasty and artificial sphincter (both under evaluation) constitue currently the promising alternatives to colostomy.