UNSUSPECTED SPHINCTER DEFECTS SHOWN BY ANAL ENDOSONOGRAPHY AFTER ANORECTAL SURGERY - A PROSPECTIVE-STUDY

PURPOSE: Anorectal surgery can lead to fecal soiling and incontinence, Whether surgery changes the anatomy and causes symptoms is unknown. A natomic changes can be visualized by anal endosonography. METHODS: We studied 50 patients after hemorrhoidectomy (24), fistulectomy (18), an d internal sphincterotomy (8). Symptoms were assessed, and anal endoso nography, anal manometry, mucosal electrosensitivity, and neurophysiol ogic tests were performed. RESULTS: In 23 (46 percent) patients, a def ect of the anal sphincter was found (13 patients had an internal sphin cter defect, 1 had an external sphincter defect, and 9 had a combined sphincter defect), 3 after hemorrhoidectomy, 13 after fistulectomy, an d 7 after internal sphincterotomy. Seven patients had symptoms, and th ey all had a sphincter defect, In the other 16 of 23 patients (70 perc ent), the sphincter defect did not produce symptoms. An internal sphin cter defect lowered maximum basal pressure and shortened sphincter len gth. CONCLUSION: Anal endosonography can reveal sphincter defects afte r anorectal surgery. Seventy percent of the patients in this group had no complaints; therefore, defects were unsuspected. This has clinical implications in the evaluation of patients with fecal incontinence.