OVERLAP REPAIR OF DAMAGED ANAL-SPHINCTER - A SINGLE SURGEONS SERIES

PURPOSE: This study was undertaken to review consecutive cases of anal sphincter repair performed by a single surgeon with respect to outcom e as measured by continence grade using the Parks-Browning scale. Othe r parameters such as manometry, pudendal nerve function, acid morbidit y are also reviewed with respect to outcome. METHODS: Thirty-one of 52 patients identified by computer were available for analysis. Case not es were retrieved, and information was transferred into a standard pro forma. Minimum follow-up was one month, and continence grade was docum ented from clinical notes recorded at follow-up. Statistical analysis was performed using Instat computer package. RESULTS: Four patients we re male, 27 were female. Average age was 41.9 years. There was no post operative mortality; postoperative morbidity was 32 percent in total, but morbidity per procedure was 19.6 percent. Most (20 of 31) patients had a clear obstetric-related cause of their anal sphincter injury. S uccessful outcome was achieved in 74.2 percent of patients. Postoperat ive anal manometry was not discriminatory between successful and faile d groups. Anal ultrasound appeared accurate in documenting residual an al sphincter defects in the poor outcome group in the small number of patients in whom it was done. Use of a stoma in covering the anal woun d while it healed was associated with less infection of the wound, but there was no statistical difference in success rate between those cov ered by a stoma and those not covered. CONCLUSIONS: Overlap repair of the damaged anal sphincter continues to give good results. Routine use of covering stomas is not supported in this small study; however, it should still be considered in difficult cases. Endoanal ultrasound may have the ability to identify those patients with poor results from an initial repair who may benefit from repeat repair.