title: Anal sphincter repair for fecal incontinence: experience from a tertiary care centre.
abstract: OBJECTIVE
  Structural anal sphincter damage may be secondary to obstetric anal sphincter injury, perineal trauma or anorectal surgery. We reviewed the spectrum of anal sphincter injuries and their outcomes in a tertiary care colorectal unit.
  
  
  METHODS
  Data of patients who underwent anal sphincter repair between 2004 and 2008 were analyzed retrospectively. Outcomes were compared with respect to etiology, type of repair, previous attempts at repair and manometry findings. Outcomes were defined as good or poor based on patient satisfaction as the primary criteria.
  
  
  RESULTS
  Thirty-four patients underwent anal sphincter repair. Twenty-two injuries were obstetric, eight traumatic, and four iatrogenic. All patients underwent overlap sphincteroplasty with six additional anterior levatorplasty and seven graciloplasty. Twenty-three (67.6%) patients had a good outcome while nine (26.4%) had a poor outcome. All patients who had augmentation anterior levatorplasty had a good outcome. Fifty percent of patients with a previous sphincter repair and 42.9% requiring augmentation graciloplasty had a poor outcome. Median resting and squeeze anal pressures increased from 57.5 to 70 cmH₂O and 90.25 to 111 cmH₂O in those with a good outcome.
  
  
  CONCLUSIONS
  Overlap sphincteroplasty has a good outcome in majority of the patients with incontinence due to a structural sphincter defect. Additional anterior levatorplasty may improve outcomes. Previous failed repairs or use of a gracilis muscle augmentation may have a worse outcome secondary to poor native sphincter muscle. Improvement in resting and squeeze pressures on anal manometry may be associated with a good outcome.
authors.affiliation: Department of Surgery Unit 5 (Colorectal Surgery), Christian Medical College and Hospital, Vellore, Tamil Nadu 632004, India.
authors.forename: Suchita
authors.initials: S
authors.lastname: Chase
authors.forename: Rohin
authors.initials: R
authors.lastname: Mittal
authors.forename: Mark Ranjan
authors.initials: MR
authors.lastname: Jesudason
authors.forename: Sukria
authors.initials: S
authors.lastname: Nayak
authors.forename: Benjamin
authors.initials: B
authors.lastname: Perakath
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D007744:Obstetric Labor Complications; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult