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Our aim was to evaluate medium-term results of transvaginal implantation of an artificial anal sphincter (AAS).Women undergoing treatment for severe fecal incontinence (FI), from 2003 to 2007 were ligible if FI had lasted for 6 months and if they had attempted other therapies without success. All patients received implantation of an AAS via a transvaginal approach. Incontinence was assessed with Wexner score.Thirty-two women entered the study (median age: 63 [26-79]). 20 (63%) had severe destruction and scarring of the perineum, which was contraindication for implantation via perineal approach. Nine patients (28.1%) hadpreviously undergone implantation of an AAS, and five had a Pickrellprocedure. mortality was none. The device was removed in nine patients (28.1%): in seven because of septic adverse events, in one because of poor function, in one for psychological reasons despite good functional results. Implantation was successful in 23 patients (71.9%), and the device remained activated for a mean of 41 (range, 18-75) months, with a mean decrease in wexner score from 18.4 to 6.8 (P < 0.0001). None of the patients complained of dyspareunia.The transvaginal approach permits treatment of women with FI who have severe damage and scarring of the anterior perineum.