Results of surgical treatment for faecal incontinence

This prospective study was designed to evaluate the results of anterior levatorplasty and sphincteroplasty for faecal incontinence with respect to symptomatic and physiological outcome.

Thirty-one patients with idiopathic (neurogenic) faecal incontinence underwent anterior levatorplasty and 20 patients with traumatic anal sphincter injury underwent anal sphincteroplasty. The outcome of repair was evaluated at 3 and 12 months using a validated questionnaire and anorectal manometry/manovolumetry.

Eighteen of 31 patients in the levatorplasty group reported continence to solid and liquid stools 1 year after operation compared with two patients before surgery (P < 0.01). The corresponding figures in the sphincteroplasty group were ten and two of 20 respectively (P < 0.05). The incontinence score was improved in both groups after 1 year, from a median score of 14 to 3 in the levatorplasty group (P < 0.001) and from 8.5 to 3.5 in the sphincteroplasty group (P < 0.01). Improvements in the degree of social and physical handicap were also observed in both groups. No changes were seen in anal canal pressures or rectal sensation in either group.

Despite different aetiologies and surgical approaches, anterior levatorplasty and sphincteroplasty yielded similarly successful results in patients with faecal incontinence. Although a marked symptomatic improvement was seen in both groups, no associated physiological alterations could be detected. The reason for the improvement is thus unclear, but it may result from a stenosing effect in the anal canal.