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Anal sphincter reconstruction for incontinence due to non-obstetric sphincter damage
1Department of Surgery, University of Natal and King Edward VIII Hospital, Durban, Congella, South Africa.
Insights
Anal sphincter reconstruction effectively treats non-obstetric anal incontinence, with most patients achieving continence after surgery. This surgical repair offers good short-term outcomes for anal sphincter damage.
Area of Science:
- Colorectal Surgery
- Gastroenterology
- Pelvic Floor Disorders
Background:
- Anal incontinence can result from non-obstetric anal sphincter damage.
- Surgical repair aims to restore anal sphincter function and continence.
Purpose of the Study:
- To evaluate the outcomes of anal sphincteroplasty in patients with anal incontinence.
- To assess the effectiveness of surgical reconstruction for non-obstetric anal sphincter damage.
Main Methods:
- Prospective study of 14 patients undergoing anal sphincter reconstruction.
- Procedures included scar excision and sphincter apposition or reefing technique.
- Median follow-up was six months post-injury.
Main Results:
- Sphincter damage causes included trauma, hemorrhoidectomy, sepsis, and fistula repair failure.
- 11 patients (79%) achieved complete continence after initial repair.
- Two patients required further repair for complete continence; one had mild residual incontinence.
Conclusions:
- Anal sphincter reconstruction provides good short-term results for non-obstetric anal incontinence.
- Surgical repair is a viable option for restoring continence after sphincter damage.
Objective:
To assess the outcome after anal sphincteroplasty in patients with anal incontinence following non-obstetric anal sphincter damage.
Design:
A prospective study carried out in an urban teaching hospital over five years (1994-1998).
Patients And Methods:
Fourteen patients, median age of 30 years, all undergoing anal sphincter reconstruction. The procedure was performed under general or regional anaesthesia. Operative management was (i) excision of the scar tissue and apposition of the cut ends of the sphincter or (ii) a reefing technique.
Results:
Sphincter damage was as a result of trauma in nine cases, haemorrhoidectomy in two cases, sepsis in two and failed recto-vaginal fistula repair in one case. In six patients with traumatic sphincter damage a colostomy was performed at original operation. The other eight presented with incontinence, four of whom required a diverting colostomy prior to repair. The median delay between sphincter injury and repair was six months (range 4-120). The posterior approach was used in eight patients, an anterior approach in five and both approaches in one. Non-absorbable suture material was used in six and absorbable material was used in eight patients. Twelve of the 14 patients had scar tissue at the site of damage requiring excision. Two post-haemorrhoidectomy patients underwent the reefing technique. Eleven patients (79%) were completely continent after initial repair. Two required further repair resulting in complete continence. One patient remained with mild incontinence.
Conclusion:
Anal sphincter reconstruction for non-obstetric anal incontinence produced good short-term results.
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