Results of surgical treatment for faecal incontinence

Background: This prospective study was designed to evaluate the results of anterior levatorplasty and sphincteroplasty for faecal incontinence with re spect to symptomatic and physiological outcome. Methods: Thirty-one patients with idiopathic (neurogenic) faecal incontinen ce underwent anterior levatorplasty and 20 patients with traumatic anal sph incter injury underwent anal sphincteroplasty. The outcome of repair was ev aluated at 3 and 12 months using a validated questionnaire and anorectal ma nometry/manovolumetry. Results: Eighteen of 31 patients in the levatorplasty group reported contin ence to solid and liquid ;stools 1 year after operation compared with two p atients before surgery (P<0.01). The corresponding figures in the sphincter oplasty group were ten and two of 20 respectively (P <0.05). The incontinen ce score was improved in both groups after I year, from a median score of 1 4 to 3 in the levatorplasty group (P<0.001) and from 8.5 to 3.5 in the sphi ncteroplasty group (P<0.01). Improvements in the degree of social and physi cal handicap were also observed in both groups. Na changes were seen in ana l canal pressures or rectal sensation in. either group. Conclusion: Despite different aetiologies and surgical approaches, anterior levatorplasty and sphincteroplasty yielded similarly successful results in patients with faecal incontinence. Although a marked symptomatic improveme nt was seen in both groups, no associated physiological alterations could b e detected. The reason for the improvement is thus unclear, but it may resu lt from a stenosing effect in the anal canal.