There is a paucity of information on the choice of suture material. Parnell and coworkers [10] investigated the use of permanent versus absorbable sutures in overlapping anal sphincteroplasty specifically related to loss of solid stool and severity of incontinence symptoms. Four surgeons performed the overlapping technique with no separation of the IAS and EAS . Each surgeon used their preferred suture material. Permanent suture types included Gore-Tex^® (Gore Medical, Neward, DE, USA), Nurolon^® (Ethicon, Somerville, NJ, USA), and Ethibond^® (Ethicon, Somerville, NJ, USA), while absorbable sutures were Vicryl and PDS. Forty patients were included in the study with 20 in the permanent suture group and 20 in the absorbable group. The primary endpoint was loss of solid stool greater than 1–3 times per month. The groups had similar rates of overall incontinence to solid stool, but the use of permanent suture was associated with decreased severity of fecal incontinence and fewer social limitations. Complications of wound separation and wound infection occurred equally in both groups. Three suture erosions occurred in the permanent suture group and one in the absorbable group, all of which were managed in the clinic. Studies of suture type in sphincteroplasty and posterior repair or sacrospinous ligament suspension have indicated higher rates of infection with braided permanent sutures. This study suggests that permanent monofilament sutures may reduce the risk of infection associated with braided permanent sutures.

Once the sphincter repair is complete, the edges of the wound are approximated in a V shape or longitudinally with interrupted 3.0 Vicryl mattress sutures. The center of the wound can be left open, a small drain inserted, or the wound can be closed.