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Outcome of Anterior Sphincter Repair for Obstetric Injury: Comparison of Early and Late Results

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Diseases of the Colon & Rectum

INTRODUCTION

Fecal incontinence is commonly caused by structural sphincter damage secondary to obstetric trauma. Anterior sphincter repair achieves reasonable early improvement rates of between 69 and 97 percent. Few series have reported long-term results. This study was designed to evaluate the long-term outcome and examine whether there are any predictive factors that could refine patient selection and predict long-term outcome.

METHODS

The case records of all patients who underwent anterior sphincter repair between January 1991 and December 1999 were studied. The patients were sent a questionnaire that asked about preoperative and postoperative and current bowel function, with questions about quality of life and overall satisfaction with the outcome of the procedure. The late outcome after a mean period of 70 months from the operation was compared with the early clinical results. All the preoperative and operative variables were studied to ascertain their significance in predicting success.

RESULTS

Ninety-three patients were admitted to the study. Anterior sphincter repair was successful in improving continence in 73 percent of patients. Long-term results were obtained for 62 patients. Seventy percent had objective clinical improvement based on the questionnaire, but only 55 percent considered their bowel control had improved and only 45 percent were satisfied by the operation. Urgency was the most important symptom in determining patient satisfaction; 24 of 26 patients in whom urgency had improved were happy with their outcome. None of the preoperative and operative variables predicted the outcome.

CONCLUSIONS

Patients should be warned that complete continence is difficult to achieve and that symptoms tend to deteriorate with time.

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REFERENCES

  1. ES Kiff M Swash (1984) ArticleTitleSlowed conduction in the pudendal nerves in idiopathic fecal incontinence Br J Surg 71 614–6 Occurrence Handle1:STN:280:DyaL2c3lvVejsQ%3D%3D Occurrence Handle6743983

    CAS  PubMed  Google Scholar 

  2. SJ Burnett C Spence-Jones CT Speakman MA Kamm CN Hudson CI Bartram (1991) ArticleTitleUnsuspected sphincter damage following childbirth revealed by anal endosonography Br J Radiol 64 225–7 Occurrence Handle1:STN:280:DyaK3M3hsFersg%3D%3D Occurrence Handle2021796 Occurrence Handle10.1259/0007-1285-64-759-225

    Article  CAS  PubMed  Google Scholar 

  3. JM Jorge SD Wexner (1993) ArticleTitleEtiology and management of fecal incontinence Dis Colon Rectum 36 77–97 Occurrence Handle1:STN:280:DyaK3s7gsFOnug%3D%3D Occurrence Handle8416784

    CAS  PubMed  Google Scholar 

  4. JF Johanson J Lafferty (1996) ArticleTitleEpidemiology of fecal incontinence: the silent affliction Am J Gastroenterol 91 33–6 Occurrence Handle1:STN:280:DyaK287ksFakug%3D%3D Occurrence Handle8561140

    CAS  PubMed  Google Scholar 

  5. AG Parks JF McPartlin (1971) ArticleTitleLate repair of injuries of the anal sphincter Proc R Soc Med 64 1187–9 Occurrence Handle1:STN:280:DyaE38%2FntlWisg%3D%3D Occurrence Handle5131253

    CAS  PubMed  Google Scholar 

  6. EE London-Shimmer R Garcia-Duperly RJ Nicholls JK Ritchie PR Hawley JP Thomson (1994) ArticleTitleOverlapping anal sphincter repair for fecal incontinence due to sphincter trauma: five year follow-up functional results Int J Colorectal Dis 9 110–3 Occurrence Handle8064190

    PubMed  Google Scholar 

  7. J Christiansen IK Pedersen (1987) ArticleTitleTraumatic anal incontinence: results of surgical repair Dis Colon Rectum 30 189–91 Occurrence Handle1:STN:280:DyaL2s7mtFWluw%3D%3D Occurrence Handle3549197

    CAS  PubMed  Google Scholar 

  8. GC Ctercteko VW Fazio DG Jagelmann IC Lavery FL Weakley M Melia (1988) ArticleTitleAnal sphincter repair: a report of 60 cases and review of the literature ANZ J Surg 58 703–10 Occurrence Handle1:STN:280:DyaL1M3ntlSjtg%3D%3D

    CAS  Google Scholar 

  9. L Oliveira J Pfeifer SD Wexner (1996) ArticleTitlePhysiological and clinical outcome of anterior sphincteroplasty Br J Surg 83 502–5 Occurrence Handle1:STN:280:DyaK283mtlWnsg%3D%3D Occurrence Handle8665241

    CAS  PubMed  Google Scholar 

  10. MR Sangalli MC Marti (1994) ArticleTitleResults of sphincter repair in post-obstetric fecal incontinence J Am Coll Surg 179 583–6 Occurrence Handle1:STN:280:DyaK2M%2FktVWqsg%3D%3D Occurrence Handle7952463

    CAS  PubMed  Google Scholar 

  11. JW Fleshman WR Peters EI Shemesh RD Fry IJ Kodner (1991) ArticleTitleAnal sphincter reconstruction: anterior overlapping muscle repair Dis Colon Rectum 34 739–43 Occurrence Handle1:STN:280:DyaK38%2Fgs12ktw%3D%3D Occurrence Handle1914735

    CAS  PubMed  Google Scholar 

  12. SD Wexner F Marchetti DG Jagelman (1991) ArticleTitleThe role of sphincteroplasty for fecal incontinence re-evaluated: a prospective physiologic and functional review Dis Colon Rectum 34 22–30 Occurrence Handle1:STN:280:DyaK3M7itF2gtA%3D%3D Occurrence Handle1991416

    CAS  PubMed  Google Scholar 

  13. CJ Young MN Mathur AA Eyers MJ Solomon (1998) ArticleTitleSuccessful overlapping anal sphincter repair: relationship to patient age, neuropathy, and colostomy formation Dis Colon Rectum 41 344–9 Occurrence Handle1:STN:280:DyaK1c7ntleltw%3D%3D Occurrence Handle9514430

    CAS  PubMed  Google Scholar 

  14. AF Engel MA Kamm AH Sultan CI Bartram RJ Nicholls (1994) ArticleTitleAnterior anal sphincter repair in patients with obstetric trauma Br J Surg 81 1231–4 Occurrence Handle1:STN:280:DyaK2M%2FktFWltQ%3D%3D Occurrence Handle7953372

    CAS  PubMed  Google Scholar 

  15. H Hasegawa K Yoshioka MR Keighley (2000) ArticleTitleRandomized trial of fecal diversion for sphincter repair Dis Colon Rectum 43 961–4 Occurrence Handle1:STN:280:DC%2BD3czmsFKisQ%3D%3D Occurrence Handle10910243

    CAS  PubMed  Google Scholar 

  16. AJ Malouf CS Norton AF Engel RJ Nicholls MA Kamm (2000) ArticleTitleLong-term results of overlapping anterior anal-sphincter repair for obstetric trauma Lancet 355 260–5 Occurrence Handle1:STN:280:DC%2BD3c7jslGgtQ%3D%3D Occurrence Handle10675072

    CAS  PubMed  Google Scholar 

  17. S Karoui AM Leroi E Koning JF Menard F Michot P Denis (2000) ArticleTitleResults of sphincteroplasty in 86 patients with anal incontinence Dis Colon Rectum 43 813–20 Occurrence Handle1:STN:280:DC%2BD3czhsFKitw%3D%3D Occurrence Handle10859083

    CAS  PubMed  Google Scholar 

  18. AL Halverson TL Hull (2002) ArticleTitleLong-term outcome of overlapping anal sphincter repair Dis Colon Rectum 45 345–8 Occurrence Handle12068192

    PubMed  Google Scholar 

  19. MS Slade SM Goldberg JL Schottler EG Balcos CE Christenson (1977) ArticleTitleSphincteroplasty for acquired anal incontinence Dis Colon Rectum 20 33–5 Occurrence Handle1:STN:280:DyaE2s%2FptVKjsA%3D%3D Occurrence Handle832558

    CAS  PubMed  Google Scholar 

  20. CJ Vaizey E Carapeti JA Cahill MA Kamm (1999) ArticleTitleProspective comparison of fecal incontinence grading systems Gut 44 77–80 Occurrence Handle1:STN:280:DyaK1M%2FotFKmuw%3D%3D Occurrence Handle9862829 Occurrence Handle10.1136/gut.44.1.77

    Article  CAS  PubMed  Google Scholar 

  21. CM Byrne CK Pager J Rex R Roberts MJ Solomon (2002) ArticleTitleAssessment of quality of life in the treatment of patients with neuropathic fecal incontinence Dis Colon Rectum 45 1431–6 Occurrence Handle12432287

    PubMed  Google Scholar 

  22. JW Briel LM Boer De WC Hop WR Schouten (1998) ArticleTitleClinical outcome of anterior overlapping repair with internal anal sphincter imbrication Dis Colon Rectum 41 209–14 Occurrence Handle1:STN:280:DyaK1c3hsFGgsQ%3D%3D Occurrence Handle9556246

    CAS  PubMed  Google Scholar 

  23. T Pinta ML Kylanpaa-Back T Salmi HJ Jarvinen P Luukkonen (2003) ArticleTitleDelayed sphincter repair for obstetric ruptures: analysis of failure Colorectal Dis 5 73–8 Occurrence Handle1:STN:280:DC%2BD3s3ls1Gktw%3D%3D Occurrence Handle12780931

    CAS  PubMed  Google Scholar 

  24. J Hill G Hosker ES Kiff (2002) ArticleTitlePudendal nerve terminal motor latency measurements: what they do and do not tell us Br J Surg 89 1268–9 Occurrence Handle1:STN:280:DC%2BD38vos1CqsQ%3D%3D Occurrence Handle12296894

    CAS  PubMed  Google Scholar 

  25. N Nikiteas S Korsgen D Kumar MR Keighley (1996) ArticleTitleAudit of sphincter repair: factors associated with poor outcome Dis Colon Rectum 39 1164–70 Occurrence Handle1:STN:280:DyaK28vivVCgsA%3D%3D Occurrence Handle8831535

    CAS  PubMed  Google Scholar 

  26. R Gilliland DF Altomare H Moreira L Oliveira JE Gilliand SD Wexner (1998) ArticleTitlePudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty Dis Colon Rectum 41 1516–22 Occurrence Handle1:STN:280:DyaK1M%2FnsFKktw%3D%3D Occurrence Handle9860332

    CAS  PubMed  Google Scholar 

  27. YP Sangwan JA Coller RC Barrett et al. (1996) ArticleTitleUnilateral pudendal neuropathy: impact on outcome of anal sphincter repair Dis Colon Rectum 39 686–9 Occurrence Handle1:STN:280:DyaK283kvFSrtg%3D%3D Occurrence Handle8646958

    CAS  PubMed  Google Scholar 

  28. S Laurberg M Swash MM Henry (1988) ArticleTitleDelayed external sphincter repair for obstetric tear Br J Surg 75 786–8 Occurrence Handle1:STN:280:DyaL1M%2FgtFyqtQ%3D%3D Occurrence Handle3167529

    CAS  PubMed  Google Scholar 

  29. M Pinho J Ortiz M Oya B Panagamuwa J Aspere MR Keighley (1992) ArticleTitleTotal pelvic floor repair for the treatment of neuropathic fecal incontinence Am J Surg 163 340–3 Occurrence Handle1:STN:280:DyaK387ntFSksA%3D%3D Occurrence Handle1539770

    CAS  PubMed  Google Scholar 

  30. P Aitola KM Hiltunen M Matikainen (2000) ArticleTitleFunctional results of anterior levatoroplasty and external sphincter plication for fecal incontinence Ann Chir Gynaecol 89 29–32 Occurrence Handle1:STN:280:DC%2BD3c3ltVarsw%3D%3D Occurrence Handle10791642

    CAS  PubMed  Google Scholar 

  31. R Miller WJ Orrom H Cornes G Duthie DC Bartolo (1989) ArticleTitleAnterior sphincter plication and levatoroplasty in the treatment of fecal incontinence Br J Surg 76 1058–60 Occurrence Handle1:STN:280:DyaK3c%2FovF2itA%3D%3D Occurrence Handle2597950

    CAS  PubMed  Google Scholar 

  32. JW Stricker DJ Schoetz JA Coller MC Veidenheimer (1988) ArticleTitleSurgical correction of anal incontinence Dis Colon Rectum 31 533–40 Occurrence Handle1:STN:280:DyaL1c3ntFSltg%3D%3D Occurrence Handle3391061

    CAS  PubMed  Google Scholar 

  33. OO Rasmussen L Puggaard J Christiansen (1999) ArticleTitleAnal sphincter repair in patients with obstetric trauma: age affects outcome Dis Colon Rectum 42 193–5 Occurrence Handle1:STN:280:DyaK1M3is1CktQ%3D%3D Occurrence Handle10211495

    CAS  PubMed  Google Scholar 

  34. B Draganic AA Eyers MJ Solomon (2001) ArticleTitleIsland flap perineoplasty decreases the incidence of wound breakdown following overlapping anterior sphincter repair Colorectal Dis 3 387–91 Occurrence Handle1:STN:280:DC%2BD3s3msFSmtw%3D%3D Occurrence Handle12790935

    CAS  PubMed  Google Scholar 

  35. CG Baeten J Konsten F Spaans et al. (1991) ArticleTitleDynamic graciloplasty for treatment of fecal incontinence Lancet 338 1163–5 Occurrence Handle1:STN:280:DyaK38%2Fkslyktw%3D%3D Occurrence Handle1682590

    CAS  PubMed  Google Scholar 

  36. I Sielzneff AJ Malouf DC Bartolo A Pryde S Douglas (1999) ArticleTitleDynamic graciloplasty in the treatment of patients with fecal incontinence Br J Surg 86 61–5 Occurrence Handle10027361

    PubMed  Google Scholar 

  37. J Christiansen M Lorentzen (1989) ArticleTitleImplantation of artificial sphincter for anal incontinence: report of five cases Dis Colon Rectum 32 432–6 Occurrence Handle1:STN:280:DyaL1M3jtFejtw%3D%3D Occurrence Handle2714136

    CAS  PubMed  Google Scholar 

  38. RD Madoff CG Baeten J Christiansen et al. (2000) ArticleTitleStandards for anal sphincter replacement Dis Colon Rectum 43 135–41 Occurrence Handle1:STN:280:DC%2BD3c7lvF2mtQ%3D%3D Occurrence Handle10696884

    CAS  PubMed  Google Scholar 

  39. KE Matzel U Stadelmaier U Hohenfellner FP Gall (1995) ArticleTitleElectrical stimulation of sacral spinal nerves for treatment of fecal incontinence Lancet 346 1124–7 Occurrence Handle1:STN:280:DyaK28%2Fjs1Chtw%3D%3D Occurrence Handle7475602

    CAS  PubMed  Google Scholar 

  40. AJ Malouf CJ Vaizey RJ Nicholls MA Kamm (2000) ArticleTitlePermanent sacral nerve stimulation for fecal incontinence Ann Surg 232 143–8 Occurrence Handle1:STN:280:DC%2BD3czitVGjtw%3D%3D Occurrence Handle10862207

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Colorectal Surgery, Western General Hospital of Edinburgh, Edinburgh, United Kingdom

    Luigi Zorcolo M.D., Luca Covotta M.D. & David C. C. Bartolo M.S., F.R.C.S.

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  1. Luigi Zorcolo M.D.
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  2. Luca Covotta M.D.
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  3. David C. C. Bartolo M.S., F.R.C.S.
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Correspondence to David C. C. Bartolo M.S., F.R.C.S..

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Zorcolo, L., Covotta, L. & Bartolo, D. Outcome of Anterior Sphincter Repair for Obstetric Injury: Comparison of Early and Late Results. Dis Colon Rectum 48, 524–531 (2005). https://doi.org/10.1007/s10350-004-0770-1

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  • DOI: https://doi.org/10.1007/s10350-004-0770-1

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