With the rectum retracted anteriorly, two sutures of 0 monofilament non-absorbable material were placed in the puborectalis posteriorly, above the level of the everted internal sphincter muscle.
The placement of the repair sutures in the right half of the sphincter complex is shown. One anterior and two posterior sutures were used to narrow the sphincter from side to side at the level of the
puborectalis, creating an oval opening.
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