ANAL-SPHINCTER RECONSTRUCTION IN THE ELDERLY - DOES ADVANCING AGE AFFECT OUTCOME

PURPOSE: This study was designed to determine whether advancing age af fects outcome after anal sphincter reconstruction. METHOD: Anal sphinc ter reconstruction, performed on patients 55 years of age and older, w as reviewed to determine if functional outcome was adversely affected by advancing age. A subgroup of patients was studied with anal manomet ry before and after repair and With pudendal nerve terminal motor late ncy (PNTML) before surgery. Results were compared with a younger group of patients. RESULTS: Between July 1986 and July 1991, 14 patients, a ges ranging from 55 to 81, underwent anal sphincter reconstruction usi ng an overlapping muscle repair. Ten patients were incontinent of soli d stool and four of liquid stool. Improvement was seen in 13 of 14 pat ients: 7 (50 percent) complete control, 3 (21 percent) incontinent to flatus, and 4 (29 percent) incontinent to liquid stools (including the patient who failed to improve). Ten patients were studied with a cont inuous pull-out manometric technique and PNTML: one was not improved. There was minimum change in mean maximum resting pressure (35.0-37.9 m mHg). Mean maximum squeezing pressure increased from 66 to 75 mmHg ove rall. Patients with complete control had a mean maximum squeezing pres sure of 81 mmHg compared with GO mmHg in patients with residual incont inence. Mean anterior anal sphincter length increased from 2.92 cm to 3.31 cm. PNTML was normal (2.0 +/- 0.2) on one or both sides in all ni ne patients who improved (average, 2.1). The patient who failed to imp rove had abnormal nerve function bilaterally (2.4, 2.7). CONCLUSION: A nal sphincter reconstruction can be performed in elderly patients with improvements in the majority of patients. Total control can be achiev ed by restoring maximum squeezing pressure in a patient with normal pu dendal nerve function.