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Postanal repair for fecal incontinence--is it worthwhile?
H Matsuoka1, C Mavrantonis, S D Wexner
1Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Diseases of the Colon and Rectum
|November 23, 2000
Summary
Postanal repair for fecal incontinence in patients without sphincter defects has a low success rate of 35%. Preoperative testing did not predict outcomes, suggesting careful patient selection for this procedure.
Area of Science:
- Colorectal surgery
- Gastroenterology
- Pelvic floor disorders
Background:
- Idiopathic or neurogenic fecal incontinence without an isolated sphincter defect can be debilitating.
- Postanal repair is a surgical option for select patients who have failed conservative treatments.
Purpose of the Study:
- To evaluate the outcomes of postanal repair in patients with idiopathic or neurogenic fecal incontinence.
- To determine if preoperative physiologic testing predicts surgical success.
Main Methods:
- A review of 21 female patients who underwent postanal repair between 1992 and 1998.
- Preoperative assessments included anorectal manometry, pudendal nerve terminal motor latency, electromyography, and endoanal ultrasonography.
- Outcomes were assessed via telephone questionnaire, with success defined as an excellent or good outcome.
Main Results:
- The overall success rate for postanal repair was 35% (7 out of 21 patients).
- No correlation was found between preoperative physiologic testing results (manometry, nerve latency, EMG) and surgical outcomes.
- Patient age, symptom duration, number of vaginal deliveries, and prior surgeries did not predict success.
Conclusions:
- Postanal repair for fecal incontinence yields a low success rate (35%) with no predictive factors identified.
- Despite the low success rate, the procedure has low morbidity and mortality, making it a potential option for carefully selected patients.
- This surgery should be reserved for individuals with severe, persistent fecal incontinence and an intact sphincter who have exhausted other treatment options or refuse them.