Endoscopic ultrasound-guided anal sphincteroplasty for fecal incontinence in women: A pilot study

Overlapping sphincteroplasty for anal sphincter injury is associated with suboptimal long-term results that can be implicated to incomplete repair and neurovascular damage during dissection. This study was done to evaluate endoscopic ultrasound-guided overlapping sphincteroplasty to ensure completeness of sphincter repair intraoperatively and also to protect the integrity of neurovascular bundles. Between January 2014 and October 2015, 15 consecutive women with damaged anal sphincters, who underwent endoscopic ultrasound-guided overlapping sphincteroplasty, were prospectively evaluated (group 1). A control group of seven women, who had undergone classical sphincteroplasty between August 2012 and December 2013, was retrospectively identified (group 2). Perioperative outcomes, anal manometry findings, and fecal incontinence scores of both the groups were analyzed. Median age of patients in group 1 was 28 years (range 21-45) whereas group 2 patients had a median age of 33 years (range 26-35). Group 1 patients were followed up for a median duration of 44 months (range 37-54), and the median follow up duration in group 2 was 62 months (range 55-70). Postoperative evaluation done at the last follow up revealed a marked improvement in anal squeeze pressures as well as St. Mark's incontinence score in both the groups compared with their preoperative status. However, there was no significant difference in the outcomes of both the groups. Use of intraoperative ultrasound ensures the completeness of sphincter repair and also decreases chances of neurovascular injury. However, no statistically significant difference in the outcome was found with the use of ultrasound-guided sphincteroplasty in the short-term.