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Related Experiment Videos

Direct repair vs. overlapping sphincter repair: a randomized, controlled trial.

J J Tjandra1, W R Han, J Goh

  • 1Department of Colorectal Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.

Diseases of the Colon and Rectum
|July 9, 2003
PubMed
Summary

Direct end-to-end and overlapping external anal sphincter repair yield similar continence outcomes. Overlapping repair may increase risks of fecal impaction and prolonged pudendal nerve terminal motor latency.

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Area of Science:

  • Colorectal Surgery
  • Female Pelvic Medicine
  • Obstetric Trauma Management

Background:

  • Obstetric trauma can cause external anal sphincter defects, impacting continence.
  • Delayed repair is an option for managing these sphincter injuries.
  • Surgical techniques for sphincter repair include direct end-to-end and overlapping methods.

Purpose of the Study:

  • To compare the efficacy of direct end-to-end versus overlapping surgical repair for delayed external anal sphincter defect reconstruction.
  • To evaluate postoperative outcomes, including continence, anal pressures, and neurophysiologic function.

Main Methods:

  • A randomized controlled trial involving 23 patients with external anal sphincter defects.
  • Patients were assigned to either direct end-to-end repair (n=12) or overlapping repair (n=11).

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  • Outcomes assessed included endoanal ultrasound, anorectal manometry, neurophysiologic evaluation, and the Cleveland Clinic Continence Score.

    • Main Results:

    • Both surgical techniques demonstrated similar improvements in continence scores and anal canal length.
    • Wound healing rates were identical; however, the overlapping group reported more fecal impaction and urinary retention.
    • One patient in the overlapping group experienced prolonged pudendal nerve terminal motor latency, and two had impaired fecal evacuation.

    Conclusions:

    • Direct end-to-end and overlapping repair techniques for external anal sphincter defects result in comparable functional outcomes.
    • Overlapping repair may be associated with a higher incidence of postoperative fecal evacuation difficulties and neurophysiologic changes.