A patient-rated, surgeon-corrected scale for functional assessment after total anorectal reconstruction

Abstract

Background and aims: To test current systems evaluating for fecal continence after total anorectal reconstruction (TAR) we adapted the incontinence plus evacuation scoring system proposed by the Working Party on Anal Sphincter Replacement (WPASR). Patients and methods: We examined 51 monthly diaries recorded by 14 patients after TAR or at yearly checks (up to 5 years). A form detailing all items and frequencies of the WPASR system was given to 12 patients who assigned a rating to each item in a frequency cell. The mean values of cells were rounded off, and a 0–20 scoring scale was obtained. We corrected the scores using previously defined criteria aimed at complying with an objective rating of severity while preserving the overall patient rating. Diaries were reevaluated by both patient-rated and surgeon-corrected scales, and the correlation was calculated to each other and to Jorge and Wexner's and the Williams et al. systems; correlations between incontinence and evacuation scores were also calculated. Results: The surgeon-corrected system tended to have a lower mean score than the patient-rated one and was strongly correlated with it (r=0.984), a significantly higher mean score than the Jorge and Wexner scale (r=0.893), and a significantly lower mean score than the Williams et al. classification (quadrupled scores; r=0.857). No correlations between incontinence and evacuation were found. Conclusions: Although not validated, the patient-rated, surgeon-corrected adjustment of the WPASR system proved in our patients a reliable instrument for functional assessment. Its consensus administration to any given patient samples requires further research.