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

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).
• 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.