Overlapping repair in patients with anal sphincter injury.
OBJECTIVE
The aim of this study was to demonstrate the improvement of anal canal function after overlap sphincter repair and confirm that this treatment option is superior in patients with nonobstetric sphincter damage.


METHODS
From 1998 to 2003, 44 women who underwent overlapping sphincter repair were enrolled in this study. The women were allocated to one of two groups, obstetric trauma (n = 31) and nonobstetric (perineal) trauma (n = 13). Both groups were compared in terms of age, operation time, number of deliveries, hospital stay, need for analgesics, complication rate, pre- and postoperative outcomes of anal manometry and quality of life, using the fecal incontinence severity index and a questionnaire for fecal disorders.


RESULTS
Anal canal length was significantly extended postoperatively in both groups compared to preoperative length. Eight-week postoperative resting and squeeze pressures were significantly higher than preoperative pressures in both patients with nonobstetric and obstetric sphincter injury. Although significant increase was seen in both groups, the mean postoperative resting and squeeze pressures at 1 year were rather high in patients with nonobstetric sphincter injury. At the end of a year of follow-up, overall satisfaction of the repair was about 82%.


CONCLUSIONS
Overlap sphincter repair was feasible, although patient satisfaction was slightly less in the obstetric than in the nonobstetric trauma group. The improvement of anal function at 20- to 24-month follow-up is attributed to both high squeeze pressure and broad anal canal.
Demirbas
Sezai
S
Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey. sezaidemirbas@hotmail.com
Atay
Vedat
V
Sucullu
Ilker
I
Filiz
A Ilker
AI
D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D036861:Delivery, Obstetric / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011247:Pregnancy; D011312:Pressure; D020127:Recovery of Function; D012086:Reoperation; D016896:Treatment Outcome