Pelvic floor procedures produce no consistent changes in anatomy or physiology.
OBJECTIVE
Postanal repair was designed to restore both anatomy and function of the anal canal in neurogenic fecal incontinence. In most series, the degree of continence is improved in fewer than 50 percent of patients. Adding anterior levatorplasty and sphincter plication (total pelvic floor repair) is claimed to improve functional results. We performed a randomized trial comparing postanal and total pelvic floor repair for neurogenic incontinence.


METHODS
Twenty female patients were studied. All had Type D incontinence (Parks and Browning). Anal manometry, defecography, and grading of the degree of continence were repeated 12 weeks after surgery to assess changes in clinical, manometric, and radiologic parameters. Statistical analysis was done using Wilcoxon's signed-rank test and Wilcoxon's two-sample test.


RESULTS
Continence improved in eight patients. Differences among clinical, manometric, and radiologic data were not statistically significant.


CONCLUSIONS
Pelvic floor repair procedures produce no consistent changes in anatomy or physiology. Clinical improvement is caused by creation of a local stenosis or by the placebo effect rather than by improvement of muscle function.
van Tets
W F
WF
Department of Surgery, Lukas-Andreas Hospital, Amsterdam, The Netherlands.
Kuijpers
J H
JH
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology; D003672:Defecation; D004312:Douglas' Pouch / Q000000981:diagnostic imaging; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography