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Long-term functional results of transvaginal anal sphincter repair for faecal incontinence; a retrospective case series

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Abstract

Introduction and hypothesis

We report our experience with a transvaginal approach with overlapping anal sphincter repair. The aim of this cohort study was to evaluate long-term functional outcomes. Women who had undergone transvaginal anal sphincteroplasty for anal incontinence from July 2005 to July 2020 and attended a multidisciplinary team of urogynaecologists and colorectal surgeons at the Mercy Hospital Perineal clinic were included.

Methods

One hundred seven women were included in the study with a median follow-up of 57.5 months. We analysed outcomes by comparing patient’s St Mark's score difference before and after surgery. Meaningful clinical difference (MID) was set at 5 points; complications and patient demographics were recorded along with a question about whether they would recommend this treatment to a friend.

Results

An improvement was seen in 69.3% of women with a marked improvement in 46.5%. Furthermore, 70% said they would recommend the procedure to a friend, if they were in a similar situation. Wound infection or partial perineal breakdown was reported in 45% of women but did not have a significant impact on outcomes.

Conclusion

Transvaginal anal sphincter repair is associated with significant improvements in patients' St. Mark's score. Our data show that the long-term success rate of transvaginal/perineal AS repair may be better than previously reported in the literature with 70% of women satisfied at 57 months. Another benefit of the transvaginal route is the possibility of performing a pelvic floor and perineal repair at the time of surgery.

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Authors and Affiliations

  1. Urogynaecology Department, Mercy Hospital for Women, Heidelberg, VIC, Australia

    Frida Carswell, Peter Dwyer, Ariel Zilberlicht, James Alexander, Alison Desousa & Lore Schierlitz

  2. Department of Surgery, St Vincent’s Hospital, Melbourne, VIC, Australia

    Madhu Bhamidipaty

  3. Department of Surgery, Eastern Health, Box Hill, VIC, Australia

    Jamie Keck & Alex Wong

Authors
  1. Frida Carswell
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  2. Peter Dwyer
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  3. Ariel Zilberlicht
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  4. James Alexander
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  5. Madhu Bhamidipaty
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  6. Alison Desousa
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  7. Jamie Keck
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  8. Alex Wong
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  9. Lore Schierlitz
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Contributions

• Main author/Corresponding author: F. Carswell. Project development, Data collection and evaluation, Manuscript writing

• Project development and supervising, Planning and editing: P. Dwyer and L. Schierlitz

• Creating of REDCap data base, Data analysis and editing: M. Bhamidipaty

• Data collection and editing: A. Zilberlicht

• Editing, Data collection and data provision: A. Wong and J. Keck

• Statistics and editing: James Alexander

Ethics was approved by the Mercy Health Human Research Ethics Committee on 10/12/2019 (more than low risk), approval number 2019-032.

Corresponding author

Correspondence to Frida Carswell.

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Carswell, F., Dwyer, P., Zilberlicht, A. et al. Long-term functional results of transvaginal anal sphincter repair for faecal incontinence; a retrospective case series. Int Urogynecol J 34, 527–534 (2023). https://doi.org/10.1007/s00192-022-05269-4

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  • DOI: https://doi.org/10.1007/s00192-022-05269-4

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