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Furthermore, the trans-anal approach affords excellent exposure of these injuries, abolishing the problem of difficult exposure in the pelvis at laparotomy. This patient's post-operative recovery was normal and she reported a Cleveland Clinic Incontinence Score of 1 at the time of hospital discharge. Can you do it too much? American Journal of Surgery. The vaginal laceration has been extended and the anal flaps developed laterally to allow identification of the retracted sphincter ends arrows.