Method of treating anal incontinence

1. A method of treating anal incontinence in a patient comprising:

establishing a pathway in tissue of the patient extending about the anal sphincter, the pathway including a first passage extending from a first pathway end laterally left and posterior to the anus through the perineum and a second passage extending from the perineum to a second pathway end laterally right and posterior to the anus; and

implanting an elongate flexible support member in and extending along said pathway to support the anal sphincter by:

making a vaginal incision in the posterior vaginal wall that extends into the perineum;

securing an end of the support member to an elongate surgical instrument at the perineum;

extending the elongate surgical instrument and the support member through the first passage;

securing a second end of the support member to an elongate surgical instrument at the perineum; and

withdrawing the elongate surgical instrument and the end of the support member through the second passage;

whereby the support member passes between the anterior side of the anal sphincter and the posterior side of the vaginal wall within the perineum.

2. The method of claim 1 wherein said support member extends about the anal sphincter through an included angle of at least about 180°, measured about an axis extending centrally and perpendicularly through the anus.

3. The method of claim 1 wherein said support member extends about the anal sphincter through an included angle of at least about 270°, measured about an axis extending centrally and perpendicularly through the anus.

4. The method of claim 1 wherein the step of establishing said pathway comprises the steps of:

making a left buttock incision in the patient's left buttock at said first pathway end; and

making a right buttock incision in the patient's right buttock at said second pathway end.

5. The method of claim 4 , wherein

the first passage extends between said left buttock incision and said vaginal incision and;

the second passage extends between said right buttock incision and said vaginal incision.

6. The method of claim 5 , wherein:

the step of establishing the first passage comprises passing an elongate surgical instrument between said left buttock incision and said vaginal incision; and

the step of establishing the second passage comprises passing an elongate surgical instrument between said right buttock incision and said vaginal incision.

7. The method of claim 1 further comprising the step of suturing said support member to the perineal body.

8. The method of claim 1 further comprising the step of tensioning said support member so as to locate said support member in a desired position relative to the anal sphincter.

9. The method of claim 1 wherein said support member is formed of a flexible mesh material.

10. The method of claim 1 further comprising the step of implanting a pelvic organ prolapse device in the patient.

11. The method of claim 1 comprising placing the support member in a supporting relationship with the anal sphincter to provide support for the external anal sphincter.

12. The method of claim 1 comprising placing a finger in the patient's anal canal and palpating a tip of the elongate surgical instrument.

13. The method of claim 1 comprising adjusting the support member with tension to draw the support member to a periphery of the anal sphincter.

14. The method of claim 1 wherein the elongate surgical instrument comprises a helical needle.

15. The method of claim 1 wherein the support member comprises a mesh sling consisting of an elongate mesh strip.

16. The method of claim 15 wherein the support member comprises a connector at a distal end.

17. The method of claim 15 wherein the support member comprises a protective sheath.

18. A method of treating anal incontinence in a patient comprising:

forming a first incision in the buttock of the patient posterior to the anus;

forming a second incision in the opposite buttock posterior to the anus;

forming a vaginal incision in the posterior vaginal wall that extends into the perineum;

forming a first tissue pathway between the first incision and the perineum by passing a surgical instrument therebetween;

forming a second tissue pathway between the perineum and the second incision by passing the surgical instrument therebetween; and

implanting a support member in the tissue pathway such that the support member is positioned around a substantial portion of the circumference of the anal sphincter and passes between the anterior side of the anal sphincter and the posterior side of the vaginal wall within the perineum by:

securing a first end of the support member to an elongate surgical instrument at the perineum;

extending the elongate surgical instrument and the support member through the first passage;

securing a second end of the support member to an elongate surgical instrument at the perineum; and

withdrawing the elongate surgical instrument through the second passage.

19. The method of claim 18 wherein

the first tissue pathway is formed by passing the surgical instrument from the first incision to the vaginal incision and the second tissue pathway is formed by passing the surgical instrument from the second incision to the vaginal incision.

20. The method of claim 18 wherein said support member extends about the anal sphincter through an included angle of at least about 180°, measured about an axis extending centrally and perpendicularly through the anus.

21. The method of claim 18 wherein said support member extends about the anal sphincter through an included angle of at least about 270°, measured about an axis extending centrally and perpendicularly through the anus.

22. The method of claim 18 comprising placing the support member in a supporting relationship with the anal sphincter to provide support for the external anal sphincter.

23. The method of claim 18 comprising placing a finger in the patient's anal canal and palpating a tip of the elongate surgical instrument.

24. The method of claim 18 comprising adjusting the support member with tension to draw the support member to a periphery of the anal sphincter.

25. The method of claim 18 wherein the surgical instrument comprises a helical needle.

26. The method of claim 18 wherein the support member comprises a mesh sling consisting of an elongate mesh strip.

27. The method of claim 26 wherein the support member comprises a connector at a distal end.

28. The method of claim 26 wherein the support member comprises a protective sheath.