Ozan Akıncı, Zehra Zeynep Keklikkıran, Yasin Tosun

Clinic of General Surgery, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye


Objective: Sphincteroplasty is of great importance in the repair of anal sphincter damage. In the present study, we compared the results of overlapping sphincteroplasty and direct apposition techniques used in anal sphincter repair.

Material and Methods: Between 2011 and 2021, 36 patients underwent sphincteroplasty for anal sphincter injury and were analysed retrospectively. Sex, age, etiologic factors, repair technique, degree of laceration, postoperative complications, length of hospital stay, time between injury and repair, follow-up time and postoperative Cleveland Clinic Incontinence Score (CCIS) were recorded for analysis, and the two techniques were compared statistically using SPSS statistics, Version 17.0.

Results: Of the sample, 31 were females and five were males, with a mean age of 31.50 ± 6.7 years. The etiologic factors were obstetric trauma in 25 patients, perianal interventions in seven patients and other traumas in four patients. The overlapping technique was applied to 14 patients and the direct apposition technique was applied to 22 patients. Mean postoperative CCIS of all cases was 5.53 ± 2.59, and was significantly lower in those who underwent overlapping sphincteroplasty technique than those who underwent apposition repair (p= 0.006). It was observed that postoperative CCIS decreased as the time between sphincter injury and repair decreased (p< 0.001; r= 0.625).

Conclusion: It is vital to repair anal sphincter damage as early as possible. The overlapping sphincteroplasty and direct apposition methods can both be considered safe for anal sphincter repair although in terms of faecal incontinence, the outcomes of overlapping sphincteroplasty are better than those of the direct apposition technique.

Keywords: Anal sphincter injury, direct apposition, fecal incontinence, overlapping sphincteroplasty

Cite this article as: Akıncı O, Keklikkıran ZZ, Tosun Y. Comparison of the outcomes of overlapping and direct apposition sphincteroplasty techniques in anal sphincter repair. Turk J Surg 2022; 38 (2): 134-139.


Ethics Committee Approval

This study was approved by Kartal Dr. Lutfi Kırdar City Hospital Clinical Research Ethics Committee (Decision number: 2021/514/205/5 Date: 27/10/2021).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - O.A.; Design - O.A., Z.Z.K.; Supervision - O.A.; Materials - Y.T., Z.Z.K.; Data Collection and/ or Processing - Y.T., Z.Z.K.; Analysis and/or Interpretation - O.A.; Literature Search - O.A., Z.Z.K.; Writing Manuscript - Z.Z.K., O.A.; Critical Reviews -O.A.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.