title: [Secondary anterior sphincteroplasty for anal incontinence after delivery].
abstract: BACKGROUND
  The prevalence of anal sphincter rupture at vaginal delivery is from 0.5 to 2.5 %. More than 50 % of these patients may need a secondary anterior sphincteroplasty because of anal incontinence.
  
  
  METHODS
  We present prospective series of 29 women (median age 45 years) operated with an overlapping anterior sphincteroplasty from 1996 to 2001. The patients were examined with anal ultrasonography (n = 23), manometry (n = 19) and neurophysiologically (n = 13), and divided into group 1 (n = 19) with anal sphincter rupture and group 2 (n = 10) with sphincter rupture as well as pudendal neuropathy. All patients (n = 29) were examined with the Cleveland Clinic incontinence score before and median eight (2-64) months after operation.
  
  
  RESULTS
  Median incontinence score before and after operation was 11.0 (0-22) versus 5.0 (0-16) (p = 0.002) for group 1; 18.0 (15-24) versus 15.5 (11-24) (p = 0.034) for group 2. There was also a significant difference between the groups concerning incontinence scores both preoperatively (p = 0.045) and postoperatively (p = 0.028). An improvement of continence was seen in 15 (79 %) of the patients in group 1 compared to 4 patients (40 %) in group 2. In group 1 a significant increase of median resting and squeeze pressures was seen.
  
  
  CONCLUSIONS
  Anterior sphincteroplasty improves anal continence considerably in patients with isolated sphincter rupture. However, patients with evidence of pudendal neuropathy must be informed that they should expect only a minor improvement in continence after operation.
authors.affiliation: Gastrokirurgisk avdeling, Ullevål universitetssykehus, Oslo. egil.johnson@ulleval.no
authors.forename: Egil
authors.initials: E
authors.lastname: Johnson
authors.forename: Erik
authors.initials: E
authors.lastname: Carlsen
authors.forename: Odd
authors.initials: O
authors.lastname: Mjåland
authors.forename: Ragnar
authors.initials: R
authors.lastname: Stien
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000293:injuries / Q000601:surgery*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011644:Puerperal Disorders / Q000209:etiology / Q000601:surgery*; D012421:Rupture