Between 1990 and 1992, external sphincter repair was performed in 20 patients rendered faecally incontinent after earlier fistula surgery. All were improved, 13 (65%) achieving Grade 1 or 2 continence. Postoperative ultrasound was useful in explaining the sub-optimal outcome of 3 patients who still had defects. Clinical outcome in female patients was better than in male patients. Clinical outcome was not related to the results of preoperative manometry, the site of external sphincter damage, the use of a stoma, or the occurrence of wound complications. External sphincter repair for faecal incontinence after fistula surgery achieves good results in the majority of patients.