SURGICAL-MANAGEMENT OF ANORECTAL INCONTINENCE DUE TO INTERNAL ANAL-SPHINCTER DEFICIENCY

Background The aetiology, surgical management and outcome in 15 patien ts with anorectal incontinence due to internal anal sphincter (IAS) de ficiency as a result of previous anal surgery (n = 14) or penetrating trauma (n = 1) was studied. Methods The degree of anorectal incontinen ce was scored by the Cleveland Clinic system median score was 14 (rang e 11-16) before surgery. In all patients the anal sphincter mechanism was assessed by endoanal ultrasonography. Thirteen of the 15 patients underwent either rotation (n = 5). island (n = 5) or advancement (n = 3) anoplasty to correct the contour defect in the anal canal. In thr r emaining two patients direct IAS repair was performed. Results Four of the 13 patients who underwent anoplasty developed wound breakdown as the result of infection (n = 3) or inadvertent suture removal (n = 1). A defunctioning stoma was required in three of these patients but all of these have been closed. At median follow-up of 34 (range 6-72) mon ths. all patients who underwent anoplasty have normal defaecatory cont rol and a median continence score of 3 (range 0-4). Direct IAS repair produced no symptomatic improvement in either patient, Conclusion Thes e results suggest that anoplasty deserves further evaluation in the tr eatment of anorectal incontinence due to discrete LAS defects, but tha t the place of IAS repair remains uncertain.