Anterior anal sphincter repair: results in a district general hospital.
OBJECTIVE
Previous series have evaluated the overlapping anterior anal sphincter repair, but with short-term follow-up and a wide range of results. We assessed our results of the anterior sphincter repair in patients with faecal incontinence.


METHODS
This was a retrospective study of 20 patients who underwent an anterior anal sphincter repair between October 1994 and July 1999. In 12 of the patients, a polypropylene mesh was inserted in the repair to act as re-inforcement. Pre-operatively, all patients had an anterior anal sphincter defect diagnosed with endo-anal ultrasound. Clinical evaluation included the patient's assessment of improvement and the Cleveland Clinic Continence Score before and after surgery. Manometric studies were performed pre-operatively and a median time of 11.5 mouths postoperatively.


RESULTS
At a median follow-up of 13 months (range, 3-61 months), 16 out of 20 (80%) patients said that surgery had improved their symptoms. There was a significant improvement in the continence score from 14 (range, 4-15) before operation to 7 (range, 0-15) after operation (P < 0.01). There were no significant differences in mean anal sphincter length, mean resting and maximum squeeze anal canal pressures before and after surgery. Similar results were obtained in patients with and without mesh re-inforcement.


CONCLUSIONS
In our institution, the overlapping anterior anal sphincter repair is successful in relieving symptoms in patients with faecal incontinence due to an anterior sphincter defect. This improvement, however, is not associated with any significant changes in anorectal manometric parameters.
Elton
Colin
C
Department of General Surgery, Eastbourne General Hospital, East Sussex, UK. colinelton@aol.com
Stoodley
Brian J
BJ
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D001004:Anus Diseases / Q000503:physiopathology / Q000601:surgery*; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D012189:Retrospective Studies; D016896:Treatment Outcome