OBJECTIVES: To assess long-term fecal incontinence symptoms after combined perineoplasty with overlapping anal sphincteroplasty using the Fecal Incontinence Severity Index (FISI) questionnaire. METHODS: A retrospective review identified all 22 subjects who had undergone perineoplasty with overlapping anal sphincteroplasty by 1 surgeon over a 6-year period. Sixteen subjects returned FISI questionnaires via mail, and demographics on all 22 were recorded. RESULTS: Only 1 of 22 subjects reported fecal incontinence 6 weeks postoperatively. Sixteen of 22 (72%) individuals returned the FISI questionnaires with mean postoperative follow-up period of 37 months (range, 6-67 months). Of these 16, 12 patients experienced only 1 to 3 episodes of fecal incontinence of liquid and solid stool per month or less. Only 1 patient reported daily incontinence of solid stool. CONCLUSION: Long-term follow-up by FISI questionnaire revealed continued satisfaction with symptom control and overall bowel function. Combined perineoplasty with overlapping anal sphincteroplasty for fecal incontinence may be an effective method for decreasing symptom frequency. © 2007 Lippincott Williams & Wilkins, Inc.