TRANSANAL ULTRASOUND AND ANORECTAL PHYSIOLOGY FINDINGS AFFECTING CONTINENCE AFTER SPHINCTEROPLASTY

PURPOSE: This study was undertaken to evaluate endosonographic and phy siologic determinants of fecal continence after sphincteroplasty. METH ODS: Sixteen female patients with severe fecal incontinence were treat ed with overlapping sphincteroplasty. Mean postoperative follow-up, wa s 12 (range, 3-48) months. All patients underwent preoperative and pos toperative transanal endosonography and anal manometry. Bilateral pude ndal nerve terminal motor latency determinations were performed in eac h patient. A physiologic continence score was used to assess stool con trol. RESULTS: Postoperatively, continence was worse, unchanged, and i mproved in one, five, and ten patients, respectively. An inverse corre lation was noted between endosonographic sphincter discontinuity posto peratively, in degrees, and the change in fecal continence after overl apping sphincteroplasty (r = -0.51; P = 0.04). Postoperative increases in sphincter resting (r = 0.6; P = 0.02) and squeeze (r = 0.54; P = 0 .03) pressures correlated with improved fecal continence. Mean pudenda l nerve terminal motor latency (r = -0.34; P = 0.20) and changes in an al sphincter length at rest (r = 0.41; P = 0.11) and squeeze (r = 0.33 ; P = 0.20) after sphincteroplasty did not significantly correlate wit h the change in continence. Patients with intact endosonographic anato my postoperatively and bilateral, unilateral, or no evidence of pudend al neuropathy had a mean change in continence score of 0.5, 1.8, and 2 .2, respectively (P = 0.48). CONCLUSIONS: Endosonography after sphinct eroplasty can identify residual sphincter defects that are significant in terms of fecal continence. Restoration of anal canal resting and s queeze pressures was related to improved fecal control after overlappi ng sphincteroplasty. Mean pudendal nerve terminal motor latency was no t significantly related to poor postoperative continence. A trend towa rd less improvement in fecal continence was noted with bilateral puden dal neuropathy.