Overlapping anal sphinctroplasty filmed using a vaginally-mounted high-definition camera. Fecal incontinence can have a devastating effect on quality of life. The most common etiology of fecal incontinence in premenopausal women is obstetrical trauma. While sacral neuromodulation has become an effective treatment option for patients with fecal incontinence, overlapping sphinctroplasty is still commonly performed for patients in whom a defect in the external anal sphincter is noted on ultrasound. This patient is a 39-year-old G4P4 Hispanic female with a history of a fourth-degree laceration and subsequent onset of fecal incontinence that occurred two years prior to presentation. Endoanal ultrasound demonstrated a defect in the external anal sphincter from 10 to 2 o'clock and no defect in the internal anal sphincter. She was taken to the operating room where we performed overlapping anal sphinctroplasty and posterior repair filmed using a high-definition mountable camera. The use of this camera for vaginal surgery improves visualization and aids in teaching. We begin by making a transverse curvilinear incision parallel to the external anal sphincter, extending approximately 180 degrees. Here, the patient is positioned in the dorsal ethotomy using candy cane stirrups. Allen stirrups for the prone jackknife position may also be utilized. Sharp dissection through the episiotomy scar is carried out posterolaterally and the rectovaginal space entered. When performing this procedure, it is important to avoid ovar dissection posterolaterally as the braches of the pudendal nerve that innervate the external anal sphincter approach from this direction. Sharp dissection continues with a finger in the rectum until the disrupted ends of the anal sphincter are reached. Once the proximal ends of the disrupted sphincter are identified, they are grasped with allosyllipses. We then use electrocautery via a needle-tip bogey to continue the dissection outlaterally to the ischial end of the anal sphincter. We then use electrocautery via a needle-tip bogey to continue the dissection outlaterally to the ischial end of the anal sphincter. We then use electrocautery via a needle-tip bogey to continue the dissection outlaterally to the ischial rectal fat and mobilize the ends of the external anal sphincter. At this point, any defect in the internal anal sphincter should be repaired. With the sphincter ends now mobilized, they are overlapped in the midline and sutured together using 2-0 delayed absorbable suture. This shaded blue box highlights the left end of the external anal sphincter. This shaded blue box highlights the right end of the external anal sphincter. Typically, 2-4 horizontal mattress stitches are placed in the suture ends left untied until the placement of all stitches is complete. This shaded blue box highlights the right end of the external anal sphincter. This shaded blue box highlights the left end of the external anal sphincter. This shaded blue box highlights the right end of the external anal sphincter. This shaded blue box highlights the left end of the external anal sphincter. This shaded blue box highlights the right end of the external anal sphincter. The perineal body is repaired by re-approximating the vulvospongiosis, transverse perineus, and raphae of the external anal sphincter in the midline using an interrupted No. 1 viral suture. The perineal skin is re-approximated using 3-0 delayed absorbable horizontal mattress sutures. The perineal skin is re-approximated using 3-0 delayed absorbable horizontal mattress sutures. The incision now takes on the classic Mercedes shape. The incision now takes on the classic Mercedes shape. Use of this high-definition camera in vaginal surgery improves learners' visualization and understanding of surgical procedures. Use of this high-definition camera in vaginal surgery improves learners' visualization and understanding of surgical procedures.

overlapping anal sphinctroplasty

fecal incontinence

obstetrical trauma

high-definition camera

surgical technique