Pj. Sitzler et Jps. Thomson, OVERLAP REPAIR OF DAMAGED ANAL-SPHINCTER - A SINGLE SURGEONS SERIES, Diseases of the colon & rectum, 39(12), 1996, pp. 1356-1360
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.