Skip to main content
Log in

Endoscopic ultrasound-guided anal sphincteroplasty for fecal incontinence in women: A pilot study

  • Short Report
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Overlapping sphincteroplasty for anal sphincter injury is associated with suboptimal long-term results that can be implicated to incomplete repair and neurovascular damage during dissection. This study was done to evaluate endoscopic ultrasound-guided overlapping sphincteroplasty to ensure completeness of sphincter repair intraoperatively and also to protect the integrity of neurovascular bundles. Between January 2014 and October 2015, 15 consecutive women with damaged anal sphincters, who underwent endoscopic ultrasound-guided overlapping sphincteroplasty, were prospectively evaluated (group 1). A control group of seven women, who had undergone classical sphincteroplasty between August 2012 and December 2013, was retrospectively identified (group 2). Perioperative outcomes, anal manometry findings, and fecal incontinence scores of both the groups were analyzed. Median age of patients in group 1 was 28 years (range 21–45) whereas group 2 patients had a median age of 33 years (range 26–35). Group 1 patients were followed up for a median duration of 44 months (range 37–54), and the median follow up duration in group 2 was 62 months (range 55–70). Postoperative evaluation done at the last follow up revealed a marked improvement in anal squeeze pressures as well as St. Mark’s incontinence score in both the groups compared with their preoperative status. However, there was no significant difference in the outcomes of both the groups. Use of intraoperative ultrasound ensures the completeness of sphincter repair and also decreases chances of neurovascular injury. However, no statistically significant difference in the outcome was found with the use of ultrasound-guided sphincteroplasty in the short-term.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77–97.

    Article  CAS  Google Scholar 

  2. Halverson AL, Hull TL. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum. 2002;45:345–8.

    Article  Google Scholar 

  3. Malouf AJ, Norton CS, Engel AF, Nicholls RJ, Kamm MA. Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet. 2000;355:260–5.

    Article  CAS  Google Scholar 

  4. Gilliland R, Altomare DF, Moreira H Jr, Oliveira L, Gilliland JE, Wexner SD. Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty. Dis Colon Rectum. 1998;41:1516–22.

    Article  CAS  Google Scholar 

  5. Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol. 2012;85:865–75.

    Article  CAS  Google Scholar 

  6. Sultan AH. Obstetric perineal injury and anal incontinence. Clin Risk. 1999;5:193–6.

    Google Scholar 

  7. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  8. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44:77–80.

    Article  CAS  Google Scholar 

  9. Thakar R, Sultan AH. Anal endosonography and its role in assessing the incontinent patient. Best Pract Res Clin Obstet Gynaecol. 2004;18:157–73.

    Article  Google Scholar 

  10. Scheer I, Thakar R, Sultan AH. Mode of delivery after previous obstetric anal sphincter injuries (OASIS)–a reappraisal? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1095–101.

    Article  Google Scholar 

  11. Zorcolo L, Covotta L, Bartolo DC. Outcome of anterior sphincter repair for obstetric injury: comparison of early and late results. Dis Colon Rectum. 2005;48:524–31.

    Article  Google Scholar 

  12. Parks AG, Mc Partlin JF. Late repair of injuries of the anal sphincter. Proc R Soc Med. 1971;74:1187–9.

    Google Scholar 

  13. Slade MS, Goldberg SM, Schottler JL, Balcos EG, Christenson CE. Sphincteroplasty for acquired anal incontinence. Dis Colon Rectum. 1977;20:33–5.

    Article  CAS  Google Scholar 

  14. Lindqvist PG, Jernetz M. A modified surgical approach to women with obstetric anal sphincter tears by separate suturing of external and internal anal sphincter. A modified approach to obstetric anal sphincter injury. BMC Pregnancy Childbirth. 2010;10:51.

    Article  Google Scholar 

  15. Zutshi M, Ferreira P, Hull T, Gurland B. Biological implants in sphincter augmentation offer a good short-term outcome after a sphincter repair. Color Dis. 2012;14:866–71.

    Article  CAS  Google Scholar 

  16. Fletcher JG, Busse RF, Riederer SJ, et al. Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders. Am J Gastroenterol. 2003;98:399–411.

    Article  CAS  Google Scholar 

  17. Rociu E, Stoker J, Eijkemans MJ, et al. Fecal incontinence: endoanal US versus endoanal MR imaging. Radiology. 1999;212:453–8.

    Article  CAS  Google Scholar 

  18. Barrett JA, Brocklehurst JC, Kiff ES, Ferguson G, Faragher EB. Anal function in geriatric patients with faecal incontinence. Gut. 1989;30:1244–51.

    Article  CAS  Google Scholar 

  19. Haadem K, Ling L, Ferno M, et al. Estrogen receptors in the external anal sphincter. Am J Obstet Gynecol. 1991;164:609–10.

    Article  CAS  Google Scholar 

  20. Engel AF, Kamm MA, Sultan AH, Bartram CI, Nicholls RJ. Anterior anal sphincter repair in patients with obstetric trauma. Br J Surg. 1994;81:1231–4.

    Article  CAS  Google Scholar 

  21. Fang DT, Nivatvongs S, Vermeulen FD, Herman FN, Goldberg SM, Rothenberger DA. Overlapping sphincteroplasty for acquired anal incontinence. Dis Colon Rectum. 1984;27:720–2.

    Article  CAS  Google Scholar 

  22. Ternent CA, Shashidharan M, Blatchford GJ, Christensen MA, Thorson AG, Sentovitch SM. Transanal ultrasound and anorectal physiology finding affecting continence after sphincteroplasty. Dis Colon Rectum. 1997;40:462–7.

    Article  CAS  Google Scholar 

  23. Savoye-Collet C, Savoye G, Koning E, et al. Anal endosonography after sphincter repair: specific patterns related to clinical outcome. Abdom Imaging. 1999;24:569–73.

  24. Grey BR, Sheldon RR, Telford KJ, Kiff ES. Anterior anal sphincter repair can be of long term benefit: a 12-year case cohort from a single surgeon. BMC Surg. 2007;7:1.

    Article  Google Scholar 

  25. Brand M, Oettle GJ. The dynamic continence challenge – a simple test to predict faecal continence before colostomy closure. S Afr J Surg. 2012;50:125–6.

    Article  Google Scholar 

  26. Tetzschner T, Sorensen M, Rasmussen OO, Lose G, Christiansen J. Reliability of pudendal nerve terminal motor latency. Int J Color Dis. 1997;12:280–4.

    Article  CAS  Google Scholar 

  27. Saraidaridis JT, Molina G, Savit LR, et al. Pudendal nerve terminal motor latency testing does not provide useful information in guiding therapy for fecal incontinence. Int J Color Dis. 2018;33:305–10.

Download references

Acknowledgments

We thank Mr. Vikas Srivastava for preparing animated video for the article.

Author information

Authors and Affiliations

Authors

Contributions

AC, SK, VisG, VivG: Study concept and protocol design;

AC, SK, PS, AD: Collecting data; analysis of data;

AC, SK, VivG: Preparing the initial draft of the manuscript;

AC, SK, PS, AD, VivG, VisG: Critical revision of the manuscript for intellectual content; study supervision.

Corresponding author

Correspondence to Saket Kumar.

Ethics declarations

Conflict of interest

AC, SK, PS, AD, VG, and VG declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Informed consent

Patients signed informed consent for their information to be used in publication.

Disclaimer

The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/ findings and content of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Presentation

Poster presentation at SAGES Annual Meeting, Houston, TX, USA (22nd–25th March 2017)

Electronic supplementary material

ESM 1

(DOCX 30 kb)

ESM 2

(DOC 28 kb)

S2 Video:

Animated video showing ineffective contraction of damaged anal sphincters with posterior displacement of neurovascular bundles. (MOV 284 kb)

S3 Video:

Animated video showing normal anal contraction with maintained position of neurovascular bundles. (MOV 451 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chandra, A., Kumar, S., Singh, P. et al. Endoscopic ultrasound-guided anal sphincteroplasty for fecal incontinence in women: A pilot study. Indian J Gastroenterol 38, 534–541 (2019). https://doi.org/10.1007/s12664-019-00956-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-019-00956-5

Keywords

Navigation