title: Long-term outcome after overlapping anterior anal sphincter repair for fecal incontinence.
abstract: OBJECTIVE
  The aim was to assess long-term results and quality of life following anterior anal sphincter repair for anal incontinence.
  
  
  METHODS
  Twenty-three female patients underwent anterior anal sphincteroplasty over a 10-year period between January 1999 and January 2009 in a gynecological surgery department. Patients were asked to complete pre- and postoperative questionnaires comprising the Jorge and Wexner incontinence score. The secondary objective was to assess pre- and post-sphincteroplasty symptom severity and sexual quality of life. Mean follow-up was 87 months (median, 91.5 months). Kaplan-Meier time-to-event analysis was applied.
  
  
  RESULTS
  Mean age was 52 years (±15.2), and mean postoperative Jorge and Wexner score, 7.5/20 (±4.1). Seventeen patients (85 %) declared themselves satisfied by the repair; 12 (60 %) showed good fecal continence. Fecal incontinence had a negative impact on quality of life for 15 % and on sexuality for 50 % of patients. Kaplan-Meier analysis showed 85 % conservation of anal continence correction at 1 year, 74 % at 48 months, 67 % at 60 months, and 48 % at 84 months.
  
  
  CONCLUSIONS
  Overlapping anterior anal sphincter repair provided lasting improvement in fecal incontinence, with satisfactory long-term functional results. At 84 months' follow-up, 48 % of patients maintained good fecal continence, with a satisfaction rate of 85 %. Anal sphincteroplasty may be a first-line attitude in young female fecal incontinence patients with a recent sphincter defect following initially undiagnosed obstetric trauma and also restores perineal comfort.
authors.affiliation: Department of Obstetrics and Gynecological Surgery, University Hospital "Femme Mère Enfant", Hospices Civils de Lyon, 59 Boulevard Pinel, Bron, 69677, Lyon, France, gery.lamblin@chu-lyon.fr.
authors.forename: Gery
authors.initials: G
authors.lastname: Lamblin
authors.forename: Paule
authors.initials: P
authors.lastname: Bouvier
authors.forename: Henri
authors.initials: H
authors.lastname: Damon
authors.forename: Philippe
authors.initials: P
authors.lastname: Chabert
authors.forename: Stephanie
authors.initials: S
authors.lastname: Moret
authors.forename: Gautier
authors.initials: G
authors.lastname: Chene
authors.forename: Georges
authors.initials: G
authors.lastname: Mellier
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D019529:Sexuality; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult