Figure 4

Retro-anal levator plate myorrhaphy: surgical steps. A: Skin incision. B: Scissors introduced between levator plate and ano-coccygeal ligament (also called intermediate loop of the external anal sphincter). C: The ano-coccygeal ligament ready to be cut (two extremities marked with a thread). D: Levator plate myorrhaphy between coccyx and ano-rectal junction until suppression of the sagging (checked by rectal examination). E: Ano-coccygeal ligament repaired. F: Skin closure with a Y-shaped multi-tubular drain at the posterior edge of the incision.