Postanal repair--do the long-term results justify the procedure?

Area of Science:

• Colorectal Surgery
• Neurogenic Bowel Dysfunction
• Fecal Incontinence Management

Background:

• Postanal repair (PAR) initially showed promise for fecal incontinence but later reports indicated declining success rates.
• Long-term outcomes and patient-reported satisfaction following PAR for neurogenic incontinence require further investigation.

Purpose of the Study:

• To evaluate long-term continence and patient satisfaction after postanal repair (PAR) in patients with neurogenic fecal incontinence.
• To correlate continence status with quality of life and overall patient satisfaction.

Main Methods:

• A telephone questionnaire assessed continence, patient satisfaction, and quality of life in patients who underwent PAR between 1986 and 2002.
• The Cleveland Clinic Incontinence Score (CCS) was used to quantify incontinence severity.

Main Results:

• Of 57 patients with a mean follow-up of 9.1 years, 79% reported satisfaction with the outcome.
• A low CCS correlated with high patient satisfaction and quality of life (QOL).
• Severe incontinence (high CCS) was associated with increased bowel frequency.

Conclusions:

• Postanal repair (PAR) is a viable treatment for selected neurogenic fecal incontinence patients, demonstrating low morbidity.
• Despite high incontinence scores in some, PAR can lead to satisfactory long-term subjective outcomes and improved quality of life.