Results of sphincteroplasty in 86 patients with anal incontinence

PURPOSE: This study was designed to analyze critically the short-term and l ong-term outcome of sphincteroplasty and to identify high-risk factors. MET HODS: Eighty-six patients with fecal incontinence associated with an ultras ound defect of the external anal sphincter were treated by anal sphincterop lasty. Clinical and physiologic assessment was made before surgery, and cli nical evaluation was made three months and an average of 40 months after su rgery. RESULTS: The evaluation of 86 patients three months after surgery sh owed that 42 patients were totally continent (49 percent), 28 were incontin ent for gas (33 percent), and 16 still had fecal incontinence (19 percent). Seventy-four patients (86 percent) were contacted 40 months after surgery. Twenty-one patients (28 percent) were totally continent, 17 were incontine nt to gas (23 percent), and 36 were incontinent to feces (49 percent). Fort y-six percent of patients felt they were clearly improved after surgery. Po or results were associated with an internal anal sphincter defect. CONCLUSI ONS: Our study suggests that in the long term, one-third of patients are to tally continent after sphincteroplasty. One-half of patients are satisfied, but only if their incontinence to feces has totally disappeared. Results o f sphincteroplasty deteriorate with time. One factor in poor prognosis is t he presence of an associated defect of the internal anal sphincter.