Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma

Background Anterior structural damage to the anal sphincter occurs in up to a third of women at first vaginal delivery, and of these a third have new bowel symptoms. The standard treatment for such structural damage is anteri or overlapping anal-sphincter repair. We aimed to assess the long-term resu lts of this operation. Methods We assessed the long-term results in 55 consecutive patients who ha d had repair a minimum of 5 years (median 77 months [range 60-96]) previous ly. Questionnaire and telephone interview assessed current bowel function a nd continence, restriction in activities related to bowel control, and over all satisfaction with the results of surgery, 42 of these patients had been continent of solid and liquid stool at a median of 15 months after the rep air. Findings We were able to contact 47 (86%) of the 55 patients. One of these patients had required a proctectomy and end ileostomy for Crohn's disease. Of the remaining 46 patients, 27 reported improved bowel control without th e need for further surgery, and 23 rated their symptom improvement as 50% o r greater. Seven patients had undergone further surgery for incontinence an d one patient had not had a covering stoma closed. Thus, the rang-term func tional outcome of the sphincter repair alone could be assessed in 38 patien ts. Of these patients, none was fully continent to both stool and flatus; o nly four were totally continent to solid and liquid stool; six had no faeca l urgency; and eight had no passive soiling. Of the 38 patients, 20 still w ore a pad for incontinence and 25 reported lifestyle restriction. 14 report ed the onset of a new evacuation disorder after sphincter repair. 23 of the 46 patients contacted had a successful long-term outcome (defined as no fu rther surgery and urge faecal incontinence monthly or less). Interpretation The results of overlapping sphincter repair for obstetric an al-sphincter damage seem to deteriorate with time. Preoperative counselling should emphasise that although most patients will improve after the proced ure, continence is rarely perfect, many have residual symptoms, and some ma y develop new evacuation disorders.