title: Long-term results of anterior anal sphincter repair for fecal incontinence due to obstetric injury / with invited commentaries.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastrointestinal Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Rothbarth
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: W J
authors.initials: WJ
authors.lastname: Meijerink
authors.forename: M E
authors.initials: ME
authors.lastname: Buyze-Westerweel
authors.forename: J G
authors.initials: JG
authors.lastname: van Dijk
authors.forename: J B
authors.initials: JB
authors.lastname: Delemarre
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000293:injuries*; D001720:Birth Injuries / Q000150:complications*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy