title: Peri-operative management of patients having external anal sphincter repairs: temporary prevention of defaecation does not improve outcomes.
abstract: OBJECTIVE
  To determine whether there was any detectable difference in outcomes of external anal sphincter repair depending on whether patients were managed routinely with a covering stoma, a constipating dietary regimen or a laxative dietary regimen in the early postoperative period.
  
  
  METHODS
  A consecutive retrospective series of 299 anal sphincter repairs undertaken on 286 patients within a single institution was studied. Patients were divided into three groups depending on the peri-operative regimen followed: routine use of a covering stoma (group 1), routine use of a postoperative constipating dietary regimen (group 2) and routine use of a laxative dietary regimen (group 3). Choice of peri-operative regimen depended on surgeon preference alone. Short-term outcomes (length of stay, complications) and long-term outcomes (functional reported degree of continence, anal ultrasound and physiology test results) were assessed in relation to peri-operative group as well as aetiology of sphincter damage.
  
  
  RESULTS
  Short-term results (complications of surgery) were obtainable in all patients; long-term results were available for 89% of patients. Length of stay was similar for all 3 groups (excluding re-admission for stoma closure). Complication rates were not significantly different between the three groups. Functional improvement in continence was reported by 68% of group 1, 69% of group 2 and 79% of group 3 (differences not statistically significant). An anatomical sphincter defect was detected postoperatively in 8% of patients in group 1, 9% in group 2 and 7% of group 3. Poorer outcomes were achieved in older patients and in patients with previous ileo-anal pouch formation. Early faecal impaction and repair breakdown were independently associated with poor long-term outcomes.
  
  
  CONCLUSIONS
  Neither routine use of a covering stoma nor a postoperative constipating regimen produced better results following external anal sphincter repair than did the use of a postoperative laxative regimen which encouraged early passage of loose stool without the need for straining.
authors.affiliation: St Mark's Hospital, Harrow, UK. Celia.Ingham.Clark@Whittington.thenhs.com
authors.forename: C L
authors.initials: CL
authors.lastname: Clark
authors.forename: K H
authors.initials: KH
authors.lastname: Wilkinson
authors.forename: H R
authors.initials: HR
authors.lastname: Rihani
authors.forename: P J
authors.initials: PJ
authors.lastname: McDonald
authors.forename: J M
authors.initials: JM
authors.lastname: Northover
authors.forename: R K
authors.initials: RK
authors.lastname: Phillips