The most frequently used operation is the over­lapping procedure (Fig. 9.2), carried out without excision of the fibrotic ends of the divided muscle, which is thought to ensure a stronger suture. However, excessive scarring itself may make over­lap impossible (Moscovitz et al., 2002). Unlike in patients who undergo post-anal repair, those who require sphincter reconstruction after trauma do not have neuropathic dystrophic sphincters; there­fore, postoperative incontinence is less frequent, ranging between 20 and 30% over the medium term in most series. Nevertheless, Evans et al. (2006) reported that only 21% of their patients were fully continent in the long term, although, according to the same authors, after 4 years anoth­er 32% had flatus incontinence only. Therefore, more than half of the patients in this series had either good or satisfactory continence over the long term following sphincter reconstruction.