The subject of surgical treatment for anal incontinence is rapidly advancing, evidenced by the fact that more and more general surgeons are performing these procedures. The condition arises in women often after childbirth. Until now anal incontinence was considered incurable; the possibility of cure means that more operations will be performed and more surgeons will need this book.

It is only in the last 25 years that the treatment of anal incontinence has become an important surgical discipline. This is not only because our understanding of the disorder has been greatly augmented by new investigative methods. It is also because the hydrocarbon industry has provided us with suitable materials with which to carry out the complex repairs that are now possible. Like most new areas of therapy, initial enthusiasm has been modified by experience. Some techniques have been amended or abandoned. Others have been shown to have very specific indications and to pe unsuitable for general use. But the total of cases treated by surgical means continues to grow, and as the field widens it is apparent that large numbers of people are still suffering from anal incontinence silently and unheard, and have been abandoned to their misery by society at large. For some of these unfortunates, the consequences are appalling: they become outcasts even within their own families; in some communities they are unable to practise their religion. They are truly regarded as "dirty", and are shunned. Because a large body of surgical experience has accrued, nowadays many of these cases can be cured, and most of them substantially alleviated. But a mis-applied or badly performed operation can be a disaster for both the patient and the surgeon.

1 Essential Anatomy of Anal Continence.- General Introduction.- Structural Anatomy.- Development.- Anal Muscles.- Blood Supply.- Venous Drainage.- Nerve Supply.- Surgical Anatomy.- The Rectum.- The Anus.- 2 Physiology of Anal Continence.- General Introduction.- Patho-physiology of Continence.- Proximal Ahmentary Canal.- Colon.- Ano-rectum.- Applied Physiology.- 3 Abdominal Techniques.- General Introduction.- Abdominal Rectopexy with Prosthetic Implant (Syn. Wells Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Abdominal Rectopexy with Prosthetic Sling (Syn. Ripstein Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Abdominal Rectopexy plus Colon Resection (Syn. Goldberg Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 4 Anterior Perineal Techniques.- General Introduction.- Anterior Plication of Puborectalis and Anal Sphincter (Syn. Anterior Buttress Technique).- Indications and Selection of Patients.- Operative Technique.- Post-operative Management.- Anterior Sling Procedure (Syn. Notaras Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 5 Posterior Perineal Techniques.- General Introduction.- Post-anal Intersphincteric Repair (Syn. Parks Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- Post-rectal Buttress Repair (Syn. Wyatt Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 6 Circum-anal Techniques.- General Introduction.- Circum-anal Wire (or Nylon) Encirclement (Syn. Thiersch Procedure).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Circum-anal Cicatrical Fixation (Syn. Saraffof Technique).- Indications and Selection of Patients.- Operative Technique.- Post-operative Management.- Results.- Gracilis Muscle Sling Technique (Syn. Pickrell-von Rapport Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 7 Per-anal Techniques.- General Introduction.- Anterior (Rectal) Mucosectomy.- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Rectal Wall Plication (Syn. Delorme Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Rectosigmoidectomy (Syn. Ahemeier Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 8 Technique of Anal Sphincter Repair (Syn. Overlap Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- 9 Techniques for Congenital Anal Deformity Encountered in Later Life.- General Introduction.- Identification and Assessment of Abnormality.- General Principles Underlying the Operations.- Selection and Preparation of Patients for Surgery.- Covered Anus Deformity with Associated Perineal Fistula ("False Anus").- Anterior Ectopic Deformity.- No Definite Anal or Puborectalis Muscle.- Ectopic Opening Adjacent to an Anal Orifice ("Shot-gun Deformity").- Cloacal-type Deformity.- Post-operative Management.- Summary.- 10 Techniques for Repair of Traumatic Injury of the Anal Sphincters.- General Introduction.- Indications and Selection of Patients.- Preparation for Surgery.- Acute Primary Repair of Traumatised Anal Sphincter and Pelvic Floor.- Operative Technique.- Post-operative Management.- Trans-vaginal Injury to the Anus and Rectum.- Repair of Acute Trans-vaginal Injury.- Operative Technique.- Post-operative Management.- Delayed Repair of Chronic Unhealed Recto-vaginal Septal Defect.- Preparation.- Operative Technique.- Post-operative Management.- 11 Techniques for Repair of Recto-vaginal Fistula.- Low Recto-vaginal Fistula.- General Introduction.- Indications and Selection of Patients.- Preparation.- Excision and Repair of Low Juxta-sphincteric Fistula.- Operative Technique.- Post-operative Management.- Per-vaginal Direct Repair of Low Supra-sphincteric Fistula.- Operative Technique.- Post-operative Management.- Per-anal Closure of Low Supra-sphincteric Fistula by Advancement Flap.- Operative Technique.- Post-operative Management.- High Recto-vaginal Fistula.- General Introduction.- Indications and Selection of Patients.- Preparation.- Direct Closure using Interposed Omental Graft.- Operative Technique.- Post-operative Management.- Extended Resection with Colo-anal Anastomosis.- Operative Technique.- Post-operative Management.