Short- and long-term results of secondary anterior sphincteroplasty in 33 patients with obstetric injury.

ABSTRACT

OBJECTIVE: To study short- and long-term improvement in obstetric anal incontinence after secondary overlapping sphincteroplasty and repeat repairs. DESIGN: A prospective analysis based on incontinence scores and patient satisfaction. SETTING: Department of Gastroenterological Surgery, Oslo University Hospital, a tertiary unit also dealing with sphincter repair. POPULATION Of 40 obstetric patients operated consecutively from February 1996 to April 2004, 33 (83%) patients with median age of 36 years were eligible for evaluation. METHODS: Wexner's and St. Mark's incontinence score, clinical examination, anal ultrasonography and manometry, and neurophysiological examination when indicated. Patient satisfaction to treatment was recorded. The patients had anterior overlapping sphincteroplasty. Five had repeat operations, four sphincteroplasty and two post-anal repair. MAIN OUTCOME MEASURES: Anal incontinence, patient satisfaction. RESULTS: The 33 patients were examined after median 7 (range 2-62) months and 103 (62-162) months. Median incontinence scores preoperatively and after short- and long-term follow-up were 12 (5-20), 7 (5-20) (p < 0.01) and 9 (0-18) (p < 0.05), respectively. Three patients (9%) had normalized anal incontinence (score ≤1) after short- and long-term follow-up. Corresponding numbers for improved anal incontinence were 22 (67%) and 16 (49%), respectively. Improvement in incontinence scores and patients' satisfaction were concordant. Symptom duration (n = 7), pudendal neuropathy (n = 6), repeat repair (n = 5) and instrument delivery (n = 3) were associated with adverse outcome. CONCLUSIONS: Improvement in anal incontinence at short-term follow-up is attenuated at long-term follow-up. Stoma formation, sacral nerve stimulation and neo-sphincter formation must be considered in compliant patients.