Long-term results of anterior anal sphincter repair for fecal incontinencedue to obstetric injury

Aims: This study is to report short- and long-term results of anterior sphi ncter repair for fecal incontinence due to obstetric injury and factors pre dicting an unsuccessful outcome. Methods: Thirty-nine consecutive patients, mean age 51 years (range 29-74), who underwent anterior sphincter repair f or fecal incontinence due to obstetric injury were investigated. Duration o f symptoms ranged from 9 months to 34 years. All patients underwent an ante rior overlapping sphincter muscle reconstruction and in most cases a pubore ctal muscle plasty. Results: Three months after surgery 77% of the patients had regained continence (Parks score of 1 or 2), at 9 months 67% were cont inent and after 12 months or more (mean, range 12-114) only 62%. Patients w ith prolonged pudendal latency (>2.2 ms) did significantly worse than patie nts without it (p < 0.05). Patients who had had lateral episiotomy during l abor had significantly better outcome than those without it (p <0.05). Conc lusion: The outcome of anterior sphincter repair deteriorates with time aft er surgery. Assessment should be done at least 1 year after surgery to eval uate the final results of anterior sphincter repair. Prolonged pudendal lat ency predicts a poor outcome of anterior sphincter repair, and a prior late ral episiotomy is possibly a good prognostic factor. Copyright (C) 2000 S. Karger AG, Basel.