PURPOSE:This study was designed to examine the role of adjuvant internal anal sphincter plication in women with neuropathic fecal incontinence undergoing pelvic floor repair.METHODS:We completed a randomized trial with symptomatic and physiologic assessment before and after surgery.RESULTS:There was no symptomatic advantage of adding internal sphincter plication; the mean improvement of functional score was 3.61±1.82 (standard deviation;P<0.01) following pelvic floor repair alone compared with 2.80±1.66 (standard deviation;P<0.01) when adjuvant internal anal sphincter plication was added. The addition of internal sphincter plication was associated with a significant fall in maximum anal resting and squeezing pressures(P<0.01).CONCLUSIONS:Addition of internal sphincter plication is not advised in women with neuropathic fecal incontinence treated by pelvic floor repair.