Anterior Anal Sphincter Repair for Fecal Incontinence: Good Longterm Results Are Possible

Abstract

Anterior anal sphincter repair (ASR) is standard treatment for fecal incontinence resulting from an obstetrically damaged anal sphincter. Longterm results of repair have generally been shown to be poor. This review of single-unit series aimed to determine longterm outcomes of primary ASR for patients with fecal incontinence from obstetrically damaged anal sphincter. This study included patients undergoing ASR from 1995 to 1999. We perform standard overlapping ASR, but external and internal sphincters are repaired separately. The internal sphincter is sutured by direct method and only if damaged. Telephone interview was conducted with all patients, after which questionnaires, including SF-36 survey, Fecal Incontinence Quality of Life Scale questions, and Wexner score-type questions, were sent at median followup of 7 years. Demographic data, anorectal physiology, and data on short-term followup (median 12 months) were prospectively collected. Sixty-four of 72 patients returned questionnaires and the operation was considered a success in 80% of patients at median followup of 84 months. Six patients underwent additional procedures for incontinence and 58 patients were analyzed. Fourteen patients reported complete continence to stool and flatus (20%). Continence had improved from median Wexner score of 14 to 7 (p < 0.001). Ninety-five percent of patients were satisfied with their operation. There was substantial improvement in all aspects of Fecal Incontinence Quality of Life Scale questionnaire and SF-36. None of the anorectal physiology variables were of value in predicting outcomes. We have shown that good longterm results can be achieved with anterior anal sphincter repair. The independent muscle repair technique could explain the improved outcomes.