Randomized trial of fecal diversion for sphincter repair

Fecal diversion for sphincter repair is controversial. This randomized trial assessed whether fecal diversion would improve primary wound healing and functional outcome after sphincter repair.

Thirty-three patients with fecal incontinence requiring sphincter repair were recruited, but only 27 agreed to be randomly assigned to a defunctioning stoma (n = 13) or no stoma (n = 14). Patients were assessed by the Cleveland Clinic Incontinence Score (0-20) and anal physiology; the mean follow-up was 34 (range, 16-47) months.

Incontinence score improved significantly in both groups (stoma, 13.5-7.8; P = 0.0072; no stoma, 14-9.6; P = 0.0470): No difference was found between the two groups. Maximum resting pressure and maximum squeeze pressure increased significantly only in the no-stoma group (maximum resting pressure, 52.4-71.3 cm H2O; maximum squeeze pressure, 87.3-100.7 cm H2O; P < 0.0001). There was no significant difference in functional outcome (stoma, 7.8; no stoma, 9.6; P = 0.4567) or the number with complications of sphincter repair (stoma, 5; no stoma, 3; P = 0.4197). However, stoma-related complications occurred in 7 of 13 patients having a stoma (parastomal hernia, 2; prolapsed stoma, 1; incisional hernia at the stoma site requiring repair, 5; and wound infection at the closure site, 1).

Fecal diversion in sphincter repair is unnecessary, because it gives no benefit in terms of wound healing or functional outcome, and it is a source of morbidity.