Overlapping sphincteroplasty is the standard surgical procedure for fecal incontinence secondary to sphincter muscle defects. The vast majority of these defects are seen in women with obstetric injuries, with only 14% of patients undergoing sphincteroplasty after anal fistula surgery. Men comprise 3-15% of all patients undergoing sphincter repair, but up to 65% of patients undergoing repair after anal fistula surgery. This video demonstrates a case of a male patient undergoing sphincteroplasty for an iatrogenic sphincter injury after fistula surgery.

The technique of anal sphincteroplasty in a male patient with a lateral defect secondary to anal fistula surgery is described.

The patient is a 45 year old man who presented after having undergone multiple procedures for perianal abscess and anal fistula at an outside institution. His complaints included seepage of stool and gas, which worsened at night. On anal examination, he had a palpable defect in the left lateral aspect and extensive scarring from his prior procedures. He underwent workup including MRI, which demonstrated a large internal and external sphincter defect in the left lateral location. The patient subsequently underwent overlapping sphincteroplasty and has done well postoperatively, with improvement in his continence.

Overlapping sphincteroplasty is most commonly performed for anterior defects in women. Short term success in men and in non-anterior locations has been demonstrated.