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Do internal anal sphincter defects decrease the success rate of anal sphincter repair?

M Oberwalder1, A Dinnewitzer, M K Baig

  • 1Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, 33331, USA.

Techniques in Coloproctology
|June 15, 2006
PubMed
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Anal sphincter repair is effective for both isolated external anal sphincter (EAS) defects and combined internal (IAS) and EAS defects. Patients with combined defects achieve similar successful outcomes to those with isolated EAS injuries.

Area of Science:

  • Colorectal surgery
  • Pelvic floor disorders
  • Anal sphincter reconstruction

Background:

  • Anatomic anal sphincter defects can affect the internal anal sphincter (IAS), external anal sphincter (EAS), or both.
  • Surgical repair options include EAS overlapping suture or imbrication, with potential addition of IAS imbrication.
  • This study compares functional outcomes of sphincter repair in patients with combined EAS/IAS defects versus isolated EAS defects.

Purpose of the Study:

  • To assess and compare the functional outcomes of anal sphincter repair in patients with combined internal and external anal sphincter defects versus those with isolated external anal sphincter defects.

Main Methods:

  • Retrospective analysis of medical records for patients who underwent anal sphincter repair between 1988 and 2000 with at least 3 months of follow-up.

Related Experiment Videos

  • Fecal incontinence assessed using the Cleveland Clinic Florida incontinence score (0-20); scores of 0-10 indicated success, 11-20 indicated failure.
  • Comparison of outcomes between patients with combined EAS/IAS defects (Group I) and isolated EAS defects (Group II).

    • Main Results:

    • 131 women included: 38 in Group I (combined defects) and 93 in Group II (isolated EAS defects).
    • No significant differences between groups in age, preoperative incontinence scores, or physiologic parameters.
    • Success rates for sphincter repair were 68.4% in Group I and 55.9% in Group II (p=NS), indicating no statistically significant difference.

    Conclusions:

    • Pre-existing internal anal sphincter (IAS) defects do not prevent successful sphincteroplasty.
    • Patients with combined anal sphincter defects (IAS and EAS) are suitable candidates for sphincter repair.
    • Functional outcomes are comparable between repairs for combined defects and isolated EAS defects.