Previous sphincter repair does not affect the outcome of repeat repair

Pasquale Giordano, Adolfo Renzi, Jonathan Efron, Pascal Gervaz, Eric G Weiss, Juan J Nogueras, Steven D Wexner
Diseases of the Colon and Rectum 2002, 45 (5): 635-40

PURPOSE: As many as 60 percent of patients present with recurrent symptoms of fecal incontinence after anterior overlapping anal sphincter repair. The aim of this study was to assess the outcome of repeat overlapping anal sphincter repair.

METHODS: All female patients with obstetric sphincter damage who underwent anterior overlapping sphincter repair between November 1988 and June 2000 were reviewed. All patients were preoperatively assessed by anorectal manometry, electromyography, and pudendal nerve terminal motor latency; manometry was repeated during follow-up. Preoperative endoanal ultrasonography was available only after 1990. Clinical outcome was assessed according to the Cleveland Clinic Florida Incontinence Score.

RESULTS: One hundred fifty-one patients were available for analysis, 115 without previous surgery and 36 after at least one previous sphincter repair. The median follow-up was 13 (range, 1-64) months and 20 (range, 2-96) months, respectively. The median incontinence score improved from 18 to 5 (P < 0.0001) in patients without previous repair and from 17.5 to 7 (P < 0.0001) in patients after previous repair. In the former group, the outcome was good in 67 (58 percent) patients, adequate in 19 (16.5 percent), and poor in 29 (25.5 percent). In the group with previous sphincter repair, the outcome was good in 18 patients (50 percent), adequate in 4 (11 percent), and poor in 14 (39 percent; P = 0.2646). The mean resting pressure increased from 20 (range, 3-43) mmHg to 24 (range, 10-44) mmHg and from 27 (range, 4-56) mmHg to 32 (range, 16-45) mmHg, respectively. The mean squeeze pressure increased from 60 (range, 23-63) mmHg to 67 (range, 33-114) mmHg and from 54 (range, 25-90) mmHg to 70 (range, 34-95) mmHg, respectively.

CONCLUSION: Previous sphincter repair does not affect clinical outcome. Repeat anterior overlapping sphincter repair yields a significant improvement in the continence score and should be considered as the treatment of choice in patients with fecal incontinence who have had previous sphincter repair and residual anterior sphincter damage.

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