title: Evaluation of anatomical and functional results of overlapping anal sphincter repair with or without the injection of bone marrow aspirate concentrate: a case-control study.
abstract: OBJECTIVE
  Overlapping anal sphincter repair (OASR) is used for treatment of faecal incontinence due to an external anal sphincter (EAS) defect; however, it is not the optimal treatment as its functional results tend to deteriorate significantly with time. The present study aimed to evaluate the effect of local injection of bone marrow aspirate concentrate (BMAC) on the outcome of OASR.
  
  
  METHODS
  We compared a prospective group of 20 patients with EAS defect who were managed with OASR and BMAC injection (group I) with a historical control group of an equal number of patients managed with OASR alone (group II). Patients were assessed preoperatively and during follow-up by the Wexner continence score and endoanal ultrasound. The primary end-points were the improvement of the continence level measured by the Wexner score and the residual EAS defect size measured by endoanal ultrasound.
  
  
  RESULTS
  At the end of follow-up, group I had significantly lower mean postoperative Wexner score (5.4 ± 7.6 vs 10.6 ± 7.4; P = 0.03) and smaller EAS defect percentage (12.2 ± 17.5 vs 18.3 ± 18.9). These findings were statistically significant in patients with a small preoperative EAS defect equal to or less than one-third of the anal circumference. Patients with larger preoperative EAS did not show a significant improvement of the continence level after repair in either group.
  
  
  CONCLUSIONS
  Augmenting OASR with local injection of BMAC in patients with faecal incontinence caused by an EAS defect, particularly a smaller defect, can improve both functional and anatomical outcomes of OASR.
authors.affiliation: General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia Providence, Egypt.
authors.forename: W W
authors.initials: WW
authors.lastname: Khafagy
authors.affiliation: General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia Providence, Egypt.
authors.forename: M M
authors.initials: MM
authors.lastname: El-Said
authors.affiliation: General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia Providence, Egypt.
authors.forename: W M
authors.initials: WM
authors.lastname: Thabet
authors.affiliation: Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia Providence, Egypt.
authors.forename: S E-S
authors.initials: SE
authors.lastname: Aref
authors.affiliation: General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia Providence, Egypt.
authors.forename: W
authors.initials: W
authors.lastname: Omar
authors.affiliation: General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia Providence, Egypt.
authors.forename: S H
authors.initials: SH
authors.lastname: Emile
authors.affiliation: General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia Providence, Egypt.
authors.forename: H
authors.identifier: http://orcid.org/0000-0003-0704-4068
authors.initials: H
authors.lastname: Elfeki
authors.affiliation: Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia Providence, Egypt.
authors.forename: M S
authors.initials: MS
authors.lastname: El-Ghonemy
authors.affiliation: General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia Providence, Egypt.
authors.forename: M T
authors.initials: MT
authors.lastname: El-Shobaky
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000601:surgery*; D001853:Bone Marrow / Q000601:surgery*; D016026:Bone Marrow Transplantation / Q000379:methods*; D016022:Case-Control Studies; D013505:Digestive System Surgical Procedures / Q000379:methods*; D019160:Endosonography / Q000379:methods; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
keywords: 
  OASR
  ; EAS defect; bone marrow aspirate concentrate; functional result