Long-term anorectal and sexual function after overlapping anterior anal sphincter repair: a case-match study.
OBJECTIVE
The purpose of this study was to assess the impact of overlapping anal sphincter repair for fecal incontinence on overall pelvic organ function.


METHODS
This study was a case-match study of 25 women undergoing overlapping anal sphincter repair from 1996 through 2003. Functional outcome was assessed using validated scoring systems. For each case, two controls matched for age and parity were assessed.


RESULTS
Twenty-one patients responded to the questionnaires; mean follow-up time was 105 (SD, 33.6) months. Analyzing the Wexner incontinence score, the group median improved from 15 (range, 4-20) before the procedure to 8 (range, 2-18; P < 0.001) at follow-up.Conversely, postoperatively there was no difference in symptoms of urinary incontinence between groups. The Female Sexual Function Index of case patients was significantly lower than that of control patients (cases, 16.2 [2.3-33.6]; controls, 26.1 [3.3-36]; P = 0.004). The Short-Form-12 physical health score was similar for both groups (mean +/- standard deviation: cases, 46.1 +/- 10.8; controls, 48.6 +/- 11.4; P = 0.220), whereas the mental health score of patients was significantly lower than that of controls (cases, 39.8 +/- 10.5; controls, 47.1 +/- 8.5; P = 0.0057).


CONCLUSIONS
Anal sphincter repair for localized sphincter defects may achieve excellent/good long-term functional results in 67 percent of patients, as judged by patients. Despite repair, continence remained significantly inferior in patients as compared with healthy control subjects. In addition, sexual function was significantly diminished in patients as compared with controls, but no correlation with the severity of fecal incontinence was found.
Riss
Stefan
S
Department of Surgery, Medical University of Vienna, Vienna, Austria.
Stift
Anton
A
Teleky
Béla
B
Rieder
Erwin
E
Mittlböck
Martina
M
Maier
Andrea
A
Herbst
Friedrich
F
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016014:Linear Models; D008365:Manometry; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011788:Quality of Life; D020127:Recovery of Function; D012725:Sexual Behavior; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome