Abstract
BackgroundEarly surgical results of anterior sphincter repair for faecal incontinence can be good, but in the longer term are often disappointing. This study aimed to determine the short and long term outcomes from anterior sphincter repair and identify factors predictive of long term success.MethodsPatients who underwent anterior sphincter repair between 1989 and 2001 in one institution were identified. Postal questionnaires were sent to patients, which included validated scoring systems for symptom severity and quality of life assessments for faecal incontinence. Patient demographics and risk factors were recorded as were the results of anorectal physiology studies and endoanal ultrasound.ResultsEighty-five patients underwent repair by one consultant. The length of follow up ranged from 1 to 12 years. Most patients (96%) had early symptom improvement postoperatively. Of the 47 patients assessed long term (≥ 5 years), 28 (60%) maintained this success. Significant improvements in quality of life were observed (P < 0.001). Neither patient, surgical nor anorectal physiology study parameters were predictive of outcome.ConclusionThere were no predictive factors of outcome success and no changes in anal manometry identified, however anterior sphincter repair remains worthwhile. Changes in compliance of the anorectum may be responsible for symptom improvement.
Highlights
Surgical results of anterior sphincter repair for faecal incontinence can be good, but in the longer term are often disappointing
The results of Anterior sphincter repair (ASR) are often good in the early post operative period, but in the longer term results are more disappointing [2]
The selection of patients with faecal incontinence for ASR was based on the history of a potential mechanism of injury and examination findings of a defect in the external anal sphincter (EAS)
Summary
Surgical results of anterior sphincter repair for faecal incontinence can be good, but in the longer term are often disappointing. Faecal incontinence can result from disruption to the anal sphincter muscles; this can be due to traumatic, surgical or obstetric causes [1]. Anterior sphincter repair (ASR), or sphincteroplasty, remains a common surgical procedure for treatment of faecal incontinence in the presence of a defect in the external anal sphincter (EAS) muscle. The results of ASR are often good in the early post operative period, but in the longer term results are more disappointing [2]. The majority of patients undergoing ASR are female, and have incurred obstetric injury to the sphincters at the time of vaginal delivery [3]. A number of studies have looked into the functional outcome following (page number not for citation purposes)
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