Long-term results of repeat anterior anal sphincter repair.

Abstract

Anterior anal sphincter repair for obstetric trauma sometimes fails because of breakdown of the repair. The long-term results of repeating the overlapping repair are not known. Twenty-three patients with repeat obstetric-related anterior sphincter repair had previously been assessed at a median of 20 months follow-up, at which time 13 patients (65 percent) felt 50 percent or greater improvement compared with their preoperative symptoms. Patients were reassessed at a median of 5 years (range, 48-86 months) using a questionnaire, an incontinence score, and telephone interview to determine current bowel function, continence, and restriction in activities of daily life and overall satisfaction with the results of surgery. Twenty-one of 23 patients (median age, 47 (range, 27-66) years) were contacted. One patient was lost to follow-up and one had died of an unrelated cause. Of 21 patients, one was fully continent and 12 more reported symptom improvement of 50 percent or more compared with preoperatively. Four were unchanged, and of the four whose symptoms had deteriorated, two had undergone further surgery for incontinence. Compared with the 20-month assessment, there was no significant change in continence scores (median, 12/20 (range, 1-20) vs. 7/20 (range, 2-19); 20 vs. 60 months), rating of improvement (median, 50 (range, 0-100) percent) at 20 and 60 months), or satisfaction (7/10 (range, 0-10) at 20 and 60 months). Repeat anterior sphincter repair results in improved continence for the majority of patients, with no substantial change between the short-term and long-term follow-up.