Anorectal physiological testing before and after a successful sphincter repair: a prospective study

Abstract

Anorectal physiological testing often yields contradictory results in patients with faecal incontinence. This prospective study aims to determine if there are any discriminatory changes in anorectal physiological testing after a successful sphincter repair for sphincter defects. From 1995 to 1998, 20 consecutive females who underwent a successful overlapping sphincter repair for sphincter defect were evaluated by anorectal manometry and neurophysiologic testing before and 2-4 months after surgery. The sphincter defect was diagnosed preoperatively by clinical and endosonographic examination, confirmed at surgery. The severity of faecal incontinence was evaluated using the Cleveland Clinic Continence Score (0-20): 0 being perfect continence, and 20 being complete incontinence. Of 20 consecutive patients who were improved following direct sphincter repair, 12 had significant improvement with a median score of 3 (range 1-6), while eight had mild improvement with a median score of 9 (range 7-12). There was a significant improvement in the mean resting anal canal pressure (80 vs 50 mmHg; P=0.016), maximum squeeze anal canal pressure (120 vs 80 mmHg; P=0.0002) and functional anal canal length (3 vs 2 cm; P=0.0069) post-operatively, with significant improvement in faecal continence following sphincter repair. However, a mild improvement in faecal continence was not associated with any significant changes in the mean resting anal canal pressure (50 vs 40 mmHg; P=0.089), maximum squeeze anal canal pressures (100 vs 100 mmHg; P=0.19) or functional anal canal length (2 vs 2 cm; P=0.47). Marked improvement of faecal continence after overlapping sphincter repair is reflected by a marked increase in the mean resting anal canal pressure, maximum squeeze anal canal pressures and functional anal canal length.