Overlapping sphincter repair: does age matter?

BACKGROUND: The predictors of the outcomes following anal sphincteroplasty have not been well documented.

OBJECTIVE: The aim was to evaluate age as a predictor of functional outcome and quality of life after overlapping sphincter repair.

DESIGN: This study is a retrospective review of chart review followed by a prospective evaluation by the use of validated questionnaires.

SETTINGS: Patients were assigned to group A (≤ 60 years old) or group B (>60 years).

PATIENTS: Included were patients with obstetric sphincter injuries who underwent overlapping sphincteroplasty between 1996 and 2007.

MAIN OUTCOME MEASURES: The Fecal Incontinence Quality of Life Scale, Fecal Incontinence Severity Index, the Cleveland Global Quality of Life scale, and a patient satisfaction questionnaire were used to assess outcome.

RESULTS: Three hundred twenty-one women underwent sphincteroplasty and 197 responded to this study, 146 (74.1%) patients in group A and 51 (25.9%) patients in group B. Median follow-up was 7.7 years (range, 4.7-10.0). The mean overall Fecal Incontinence Quality of Life Scale was 11.0 ± 3.5. Median Fecal Incontinence Severity Index score was 29.8 ± 15.9. Mean Cleveland Global Quality of Life scale was 0.7 ± 0.2. The 2 groups were comparable for BMI (p = 1.0), ethnic background (p = 0.8), smoking (p = 0.8), and follow-up duration (p = 0.9). Intergroup comparison showed no significant difference in the Fecal Incontinence Quality of Life Scale scores (p = 0.5) in all subscales: lifestyle (p = 0.8), coping behavior (p = 0.5), depression and self-perception (p = 0.2), and embarrassment (p = 0.1). No significant differences were noted in Fecal Incontinence Severity Index (p = 0.2), Cleveland Global Quality of Life scale (p =1.0), or postoperative satisfaction (p = 0.6).

LIMITATIONS: The study was limited by its retrospective nature.

CONCLUSIONS: Comparable long-term Fecal Incontinence Severity Index score and Fecal Incontinence Quality of Life Scale scores following overlapping sphincter repair suggest that age is not a predictor of outcome for overlapping sphincter repair. This procedure can be offered to both young and older patients.