POSTANAL REPAIR FOR FECAL INCONTINENCE - LONG-TERM FOLLOW-UP

Background: To determine the long-term outcome of postanal repair, and to assess whether the preoperative and physiological tests had any be aring on this outcome. Review included an opportunity for assessment w ith anal manometry and anal ultrasound. Method: Review of all patients (n = 22) over a TO year period from 1986 to 1996. Comparison was of p re-operative symptoms to symptoms at review. Correlation of outcome wi th pre-operative manometry and the results of manometry and ultrasound at review (n = 6) was determined. Results: Assessment was possible in 19 of the 22 patients. Follow-up ranged from 2 to 10 years (median, 8 years). Two had stomas created at 6 and 9 months and are considered f ailures. Seven patients considered the operation a success, in four it improved their symptoms and in six it was considered a failure. Compa rison of pre-and postoperative symptoms scores found a statistically s ignificant improvement (P = 0.0093; two-tailed Wilcoxon signed rank su m test). The outcome was not influenced by the results of pre-operativ e anal manometry. Anal ultrasound found five sphincter defects in six patients. Such defects did not preclude improvement from postanal repa ir. Conclusions: Although the results showed improvement or success in only 11 (58%) of the patients this was felt to be important given tha t these patients may have few alternatives other than complicated proc edures or a stoma. Postanal repair has a place in the management of fa ecal incontinence.