OPERATION: Anterior Sphincteroplasty with Levatorplasty — Post-Obstetric External Anal Sphincter Injury
ANAESTHETIC: General / spinal anaesthesia
POSITION: Prone jack-knife / lithotomy. Urinary catheter inserted.
INDICATION:
Faecal incontinence secondary to obstetric external anal sphincter injury. [3rd / 4th degree perineal tear]. Symptoms: [faecal urgency / incontinence to liquid / solid stool / flatus]. Wexner / St Mark's incontinence score: [value]. Preoperative investigations: endoanal USS — [anterior sphincter defect size, IAS status], anorectal manometry — [squeeze pressure, resting pressure], pudendal nerve terminal motor latency — [bilateral results]. Informed consent including discussion of limitations and realistic expectations.
PROCEDURE: