Randomized trial of internal anal sphincter plication with pelvic floor repair for neuropathic fecal incontinence

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Abstract
This study was designed to examine the role of adjuvant internal anal sphincter plication in women with neuropathic fecal incontinence undergoing pelvic floor repair. We completed a randomized trial with symptomatic and physiologic assessment before and after surgery. There was no symptomatic advantage of adding internal sphincter plication; the mean improvement of functional score was 3.61±1.82 (standard deviation; P<0.01) following pelvic floor repair alone compared with 2.80±1.66 (standard deviation; P<0.01) when adjuvant internal anal sphincter plication was added. The addition of internal sphincter plication was associated with a significant fall in maximum anal resting and squeezing pressures (P<0.01). Addition of internal sphincter plication is not advised in women with neuropathic fecal incontinence treated by pelvic floor repair.