Evidence Table 34Island advancement flap anoplasty

Study detailsPatientsInterventionsOutcome measuresEffect sizeComments
Morgan et al, 1997260

Study design: Case series

Evidence level: 3

Duration of follow-up: 34 months
Patient group: treated for incontinence during November 1989 to February 1995

Cause of FI: internal anal sphincter injury

All patients
N: 15 N with FI: 15
Age (median): 48 (32–69) yrs
M/F: 12/3
Dropouts: 0

None of the patients were incontinent to solid stool preoperatively.

Anoplasty – filling the defect in the anal canal with skin and subcutaneous fat which was achieved by raising a flap of perianal and buttock skin and subcutaneous tissue using a rotation (n=5), an advancement (n=4) or an island (n=5) technique.

The remaining patients (n=2) had a direct internal anal sphincter repair.
Median Continence Score (Cleveland continence score: 0–20): where 0 is perfect continence and 20 is complete incontinence)Preoperatively: (n=15)
Score: 14 (11–16)

Postoperatively: (n=13)
Score: 2 (0–4)*
Funding: NR

Postoperative continence score only includes patients that had anoplasty.

14 of the 15 patients had undergone previous anal surgery; haemorrhoidectomy (n=7), posterior sphincterotomy (n=3), anal fistulotomy (n=3) and local excision of a radiation-induced ulcer (n=1). Remaining patient had internal anal sphincter division due to penetrating trauma.
Results of direct internal anal sphincter repair patientsBoth failed to exhibit symptomatic improvement. One patient had anoplasty but failed to improve after 20 months follow up.
ComplicationsWound infection (n=3) and wound resuture and temporary loop colostomy after flap dislodgement occurred due to inadvertent suture removal on the third postoperative day. All complications in anoplasty group and none seen in patients that had direct internal sphincter repair.


Cover of Faecal Incontinence
Faecal Incontinence: The Management of Faecal Incontinence in Adults.
NICE Clinical Guidelines, No. 49.
National Collaborating Centre for Acute Care (UK).
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