Clinical outcome of anterior overlapping external anal sphincter repair with internal anal sphincter imbrication

Dis Colon Rectum. 1998 Feb;41(2):209-14. doi: 10.1007/BF02238250.

Abstract

Fecal incontinence caused by overt anterior sphincter defects sustained during childbirth is usually treated by a delayed overlapping repair of the external anal sphincter. However, an obstetric trauma is frequently associated with disruption of the perineal body and loss of the distal rectovaginal septum. Data regarding a combined repair, consisting of restoration of the rectovaginal septum and perineal body, overlapping external anal sphincter repair, and imbrication of the internal anal sphincter, are scanty.

Purpose: This prospective study was aimed at the following: 1) evaluating the clinical outcome of such an anterior anal repair in patients with fecal incontinence caused by obstetric trauma; 2) comparing the functional results with those obtained in a historical group of patients who underwent a conventional direct sphincter repair.

Methods: During the period between 1973 and 1989, 24 female patients (median age, 44 (range, 28-67) years) with fecal incontinence underwent direct sphincter repair (Group I). During the period between 1989 and 1994, a consecutive series of 31 female patients (median age, 46 (range, 23-78) years) with fecal incontinence underwent anterior anal repair (Group II).

Results: At two years of follow-up, continence had been restored in 15 patients (63 percent) in Group I, whereas restoration of continence was successful in 21 patients (68 percent) in Group II.

Conclusion: The more complex anterior anal repair fails to confer clinical benefit compared with the rather simple direct sphincter repair.

MeSH terms

  • Adult
  • Aged
  • Anal Canal / injuries
  • Anal Canal / pathology*
  • Anal Canal / surgery*
  • Fecal Incontinence / etiology
  • Fecal Incontinence / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Methods
  • Middle Aged
  • Obstetric Labor Complications
  • Pregnancy
  • Preoperative Care
  • Prospective Studies
  • Treatment Outcome