Advertisement

International Journal of Colorectal Disease

, Volume 21, Issue 1, pp 52–56 | Cite as

Outcome of overlapping anal sphincter repair after 3 months and after a mean of 80 months

  • Goran I. Barisic
  • Zoran V. KrivokapicEmail author
  • Velimir A. Markovic
  • Milos A. Popovic
Original Article

Abstract

Background

The aim of this study was to determine the functional results of anal sphincter repair after a long follow-up (mean 80.1 months).

Methods

In the period 1990–2002, 65 sphincter repairs were performed. Obstetric trauma was the cause of incontinence in 72.3% cases, fistulotomy in 13.8%, nonspecific trauma in 9.2%, and war injury in 4.6%. At the time of surgery, 12 patients had undergone an urgent stoma procedure. In all cases, anal manometry, electromyography, and defecography were performed. The severity of incontinence was evaluated preoperatively using the Wexner score system. Anterior sphincteroplasty was performed in 52 cases, lateral in 9 cases, and posterior in 4 cases.

Results

The results were determined according to the Wexner score system and the Browning–Parks scale. The Wexner score was calculated 3 months after operation and during every follow-up visit. Preoperative scores and those at the first and last follow-up visits were analyzed. Three months after operation excellent results were achieved in 55.5%, good in 18.5%, fair in 16.9%, and poor in 9.2% patients. After follow-up (mean 80.1 months), 26.8% had excellent results, 21.4% had good results, 12.5% had fair results, and 39.3% of patients had a poor outcome. Results determined by the Wexner score system improved from 17.8 preoperatively to 3.6 three months after operation, but deteriorated over time to 6.3 after longer follow-up (p<0.001).

Conclusion

Overlapping sphincter repair provides satisfactory results in more than two-thirds of patients initially, but the results tend to worsen over time and are satisfactory in half of patients after longer follow-up.

Keywords

Fecal incontinence Sphincter repair Quality of life 

References

  1. 1.
    Madoff RD, Baeten CG, Christiansen J et al (2000) Standards for anal sphincter replacement. Dis Colon Rectum 43:135–141Google Scholar
  2. 2.
    Cerulli MA, Nikoomanesh P, Schuster MM (1979) Progress in biofeedback conditioning for fecal incontinence. Gastroenterology 76:742–746Google Scholar
  3. 3.
    Slade MS, Goldberg SM, Schottler JL, Balcos EG, Christenson CE (1977) Sphincteroplasty for acquired anal incontinence. Dis Colon Rectum 20:33–35Google Scholar
  4. 4.
    Miller R, Orrom WJ, Cornes H, Duthie G, Bartolo DC (1989) Anterior sphincter plication and levatorplasty in the treatment of fecal incontinence. Br J Surg 76:1058–1060Google Scholar
  5. 5.
    Browning G, Parks A (1983) Postanal repair for neuropathic fecal incontinence: correlation of clinical results and anal canal pressures. Br J Surg 70:101–104Google Scholar
  6. 6.
    Fleshman JW, Peters WR, Shemesh EI, Fry RD, Kodner IJ (1991) Anal sphincter reconstruction: anterior overlapping muscle repair. Dis Colon Rectum 34:739–743Google Scholar
  7. 7.
    Pezim ME, Spencer RJ, Stanhope CR, Beart RW Jr, Ready RL, Ilustrup DM (1987) Sphincter repair for fecal incontinence after obstetrical or iatrogenic injury. Dis Colon Rectum 30:521–525Google Scholar
  8. 8.
    Wexner SD, Marchetti F, Jagelman DG (1991) The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review. Dis Colon Rectum 34:22–30PubMedGoogle Scholar
  9. 9.
    Oliveira L, Pfeifer J, Wexner SD (1996) Physiological and clinical outcome of anterior sphincteroplasty. Br J Surg 83:502–505PubMedGoogle Scholar
  10. 10.
    Yoshioka K, Keighley MR (1989) Sphincter repair for fecal incontinence. Dis Colon Rectum 32:39–42Google Scholar
  11. 11.
    Engel AF, van Baal SJ, Brummelkamp WH (1994) Late results of anterior sphincter plication for traumatic fecal incontinence. Eur J Surgery 160:633–636Google Scholar
  12. 12.
    Ctercteko GC, Fazio VW, Jagelman DG, Lavery IC, Weakley FL, Melia M (1988) Anal sphincter repair: a report of 60 cases and review of the literature. Aust NZ J Surg 58:703–710Google Scholar
  13. 13.
    Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of fecal incontinence grading systems. Gut 44:77–80PubMedGoogle Scholar
  14. 14.
    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedGoogle Scholar
  15. 15.
    Pescatori M, Anastasio G, Bottini C, Mentasti A (1992) New grading and scoring for anal incontinence: evaluation of 335 patients. Dis Colon Rectum 35:482–487PubMedGoogle Scholar
  16. 16.
    American Medical Systems (1997) Fecal incontinence scoring system. American Medical Systems, MinnetonkaGoogle Scholar
  17. 17.
    Rockwood TH, Church JM, Fleshman JW et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42:1525–1532PubMedGoogle Scholar
  18. 18.
    Rothbarth J, Bemelman WA, Meijerink WJ, Stiggelbout AM, Zwinderman AH, Buyze-Westerweel ME, Delemarre JBVM (2001) What is the impact of fecal incontinence on quality of life? Dis Colon Rectum 44:67–71PubMedGoogle Scholar
  19. 19.
    Halverson AL, Hull TL (2002) Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum 45:345–348Google Scholar
  20. 20.
    Rasmussen OØ, Puggaard L, Christiansen J (2003) Anal sphincter repair in patients with obstetric trauma. Dis Colon Rectum 46:937–942Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Goran I. Barisic
    • 1
  • Zoran V. Krivokapic
    • 1
    • 2
    Email author
  • Velimir A. Markovic
    • 1
  • Milos A. Popovic
    • 1
  1. 1.Institute for Digestive Diseases, First Surgical ClinicClinical Center of SerbiaBelgradeSerbia and Montenegro
  2. 2.First Surgical ClinicBelgradeSerbia and Montenegro

Personalised recommendations