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Anorectal physiological testing before and after a successful sphincter repair: a prospective study
1Department of Surgery, Colorectal Unit, University of Melbourne, The Royal Melbourne Hospital, Australia, The Royal Women's Hospital, Melbourne, Australia.
Summary
Successful sphincter repair significantly improves fecal continence by increasing anal canal pressures and functional length. Mild improvements, however, did not show significant physiological changes post-surgery.
Area of Science:
- Colorectal surgery
- Pelvic floor disorders
- Gastrointestinal physiology
Background:
- Faecal incontinence due to sphincter defects presents diagnostic challenges with anorectal physiological testing.
- Overlapping sphincter repair is a surgical option for sphincter defects causing faecal incontinence.
Purpose of the Study:
- To investigate discriminatory changes in anorectal physiological testing following successful overlapping sphincter repair for sphincter defects.
- To correlate physiological changes with clinical outcomes in faecal incontinence patients.
Main Methods:
- Prospective evaluation of 20 female patients undergoing overlapping sphincter repair.
- Anorectal manometry and neurophysiologic testing performed pre-operatively and 2-4 months post-operatively.
- Faecal incontinence severity assessed using the Cleveland Clinic Continence Score (0-20).
Main Results:
- Significant improvement in mean resting anal canal pressure (80 vs 50 mmHg), maximum squeeze anal canal pressure (120 vs 80 mmHg), and functional anal canal length (3 vs 2 cm) post-surgery.
- Patients with marked continence improvement showed significant physiological increases; those with mild improvement did not.
- Cleveland Clinic Continence Score improved significantly in patients with marked physiological changes.
Conclusions:
- Marked improvement in faecal continence after overlapping sphincter repair correlates with significant increases in resting and squeeze anal pressures, and functional anal canal length.
- Anorectal manometry can reflect outcomes of sphincter repair surgery for faecal incontinence.
- Physiological testing may help differentiate degrees of recovery after sphincter repair.
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