Functional results of anterior levatorplasty and external sphincter plication for faecal incontinence

Background and Aims: The aim of this study was to assess results of anterio r levatorplasty combined with external anal sphincter plication for faecal incontinence. Material and Methods: The study involved 44 female patients, 27 with idiopa thic and 17 with traumatic faecal incontinence. All underwent anterior leva torplasty and external sphincter plication in our institution between 1986 and 1997. The patients were followed up clinically for a mean 12 (range 2-5 4) months and 39 (89 %) patients also underwent pre-and postoperative anal manometry. Results: In the idiopathic group 5 patients (19 %) estimated that the resul t of the operation had been good and another 18 (67 %) reported feeling bet ter than before; the corresponding figures in the traumatic group were 4 (2 4 %) and 10 (59 %). The Wexner incontinence score decreased significantly a fter the operation in both groups. Nineteen patients (70 %) in the idiopath ic and 14 (82 %) in the traumatic group showed improvement of one or more s cores on the Kirwan scale. Three patients regained continence completely, o ne in the traumatic and two in the idiopathic group. There were no signific ant improvements in mean resting anal pressure or functional anal canal len gth in either group. Mean squeeze pressure improved significantly only in t he traumatic group. Conclusions: Although the results of anterior levatorplasty combined with e xternal sphincter plication are not perfect, the approach seems to be a val uable alternative in the treatment of patients with idiopathic or traumatic faecal incontinence. Complete continence is seldom achieved, but the grade of incontinence is reduced in the majority of patients.