Anal incontinence surgery: a small personal experience

The true incidence of faecal incontinence in Saudi Arabia is unknown and probably relatively few patients seek treatment at the present time. In order to assess the types of treatment available and their outcomes, a retrospective audit of patients presenting at King Faisal Specialist Hospital during an 8-year period has been undertaken.

Charts were examined in order to identify the cause of the incontinence, the severity and duration of the problem, the clinically determined resting and squeeze pressures, the anatomical muscular defect, the surgery performed, the surgical morbidity, the results of surgery and the length of follow up.

Thirty patients (average age 36.9 years) were surgically treated for anal incontinence. Thirteen were females. Previous fistula surgery was the commonest cause for incontinence. Nine patients had generalized sphincter weakness. The average duration of symptoms was 71.6 months. Eighteen patients had overlapping sphincter repairs, of whom eight had wounds that became infected and 13 (72%) patients were 'better'. Two of five patients were 'better' following dynamic graciloplasty. Stomata were constructed in 12 patients and six were closed. Surgery reduced mean incontinence scores (Wexner) from 10.4 to 5.0.

Overlapping sphincter repair can be safely performed for localized sphincter defects in Saudi Arabia with a high probability of improving continence. In contrast, dynamic graciloplasty is not a suitable operation for patients in this region, where cultural and social habits preclude satisfactory function of the stimulated neosphincter.