AUDIT OF POSTANAL REPAIR IN THE TREATMENT OF FECAL INCONTINENCE

PURPOSE: The short-term results of postanal repair for idiopathic feca l incontinence are satisfactory but data on long-term outcome are lack ing. This studywas carried out to document the short-term and long-ter m results of this operation and to determine whether preoperative test s predict long-term outcome. METHODS: Thirty-six patients (33 females; mean age, 57 years) with major idiopathic fecal incontinence operated on by one surgeon were studied. Patients had resting and voluntary co ntraction anal pressures and pudendal nerve terminal motor latencies ( PNTML) measured preoperatively. Symptoms were evaluated at 6 months af ter operation and again at a median of 25 (range, 6-72) months in all 36 patients. Symptoms were classified as: Group C, no improvement or w orse; Group B, minor improvement; and Group A, marked improvement in c omparison to thepatient's pre operative symptoms. Seventeen patients h ad postoperative physiology performed. RESULTS: At 6 months there were 6 (17 percent) patients in Group C, 12 (33 percent) in Group B, and 1 8 (50 percent) in Group A. At final follow-up there were 17 (47 percen t) in Group C, 9 (25 percent) in Group B, and 10 (28 percent) in Group A. Comparison of the preoperative data in the final outcome groups sh owed (mean +/- SE): Groups A and B vs. Group C-resting pressure, 24.6 +/- 6 cm H2O vs. 40.5 +/- 12.2 (P = 0.2), voluntary contraction pressu re, 23.7 +/- 5.7 vs. 11.8 +/- 3.6 (P = 0.09), and PNTML, 3.2 +/- 0.75 mS vs. 3.3 +/- 0.99 (P = 0.8). Mean differences between postoperative and preoperative results were: resting pressure, 28 +/- 8.2 cm H2O (P = 0.003); voluntary contraction pressure, 19.5 +/- 6.7 (P = 0.01); and PNTML, -0.3 +/- 0.29 mS (P = 0.3). CONCLUSIONS: At 6 months 83 percen t of patients had obtained some benefit from postanal repair but only 53 percent maintained this improvement with only 28 percent being mark edly better. There was a trend toward a more favorable outcome in pati ents with greater squeezing pressures preoperatively but other tests w ere not of long-term predictive value.