LONG-TERM RESULTS OF TOTAL PELVIC FLOOR REPAIR FOR POSTOBSTETRIC FECAL INCONTINENCE

PURPOSE: This study was designed to assess the long-term results of to tal pelvic floor repair for postobstetric neuropathic fecal incontinen ce. METHOD: Sixty-three of 75 women who had undergone total pelvic flo or repair for postobstetric neuropathic fecal incontinence were traced and interviewed a median of 36 (18-78) months after surgery. Thirty-n ine patients agreed to repeat anorectal physiology. RESULTS: Six patie nts required further surgery for persistent incontinence (colostomy, 4 ; graciloplasty, 2). For the remaining 57 patients, incontinence impro ved greatly in 28 (49 percent) patients, mildly in 13 (23 percent), an d not at all in 16 (28 percent); daily incontinence was present in 41 patients (73 percent) before the operation but persisted in 13 (23 per cent). Only eight (14 percent) patients were rendered completely conti nent; those with marked improvement were socially more active than tho se with little or no improvement. Resting and maximum squeeze pressure s, anal canal sensation, rectal sensation, and pudendal nerve terminal motor latency did not predict outcome. Perineal descent, obesity, and a history of straining before the operation were all associated with a poor outcome. CONCLUSION: Total pelvic floor repair rarely renders p atients with postobstetric neuropathic fecal incontinence completely c ontinent but substantially improves continence and lifestyle in approx imately one-half of them. The operation is less successful in obese pa tients and in those with a history of straining or perineal descent.