Long-term results of anterior anal sphincter repair for fecal incontinence due to obstetric injury / with invited commentaries

Aims: This study is to report short- and long-term results of anterior sphincter repair for fecal incontinence due to obstetric injury and factors predicting an unsuccessful outcome.

Methods: Thirty-nine consecutive patients, mean age 51 years (range 29-74), who underwent anterior sphincter repair for fecal incontinence due to obstetric injury were investigated. Duration of symptoms ranged from 9 months to 34 years. All patients underwent an anterior overlapping sphincter muscle reconstruction and in most cases a puborectal muscle plasty.

Results: Three months after surgery 77% of the patients had regained continence (Parks score of 1 or 2), at 9 months 67% were continent and after 12 months or more (mean, range 12-114) only 62%. Patients with prolonged pudendal latency (>2.2 ms) did significantly worse than patients without it (p < 0.05). Patients who had had lateral episiotomy during labor had significantly better outcome than those without it (p < 0.05).

Conclusion: The outcome of anterior sphincter repair deteriorates with time after surgery. Assessment should be done at least 1 year after surgery to evaluate the final results of anterior sphincter repair. Prolonged pudendal latency predicts a poor outcome of anterior sphincter repair, and a prior lateral episiotomy is possibly a good prognostic factor.