Abstract
PURPOSE: This study was designed to evaluate the effectiveness of overlapping anal sphincter reconstruction and to determine the manometric parameters that correlate with a successful functional outcome. METHODS: A retrospective review of patients who had undergone overlapping sphincter reconstruction for anal incontinence from 1988 to 1999 was undertaken. Only patients with preoperative and six-months-postoperative anal manometry were included in this study. Standard statistical tests were used to compare pre- and postoperative findings. RESULTS: A total of 52 overlapping sphincter reconstructions were performed on 49 patients (46 females). The mean age was 44 (± standard error, 15.8; range, 20–81) years, with follow-up at six months. Forty-two patients had a history of complicated vaginal delivery (episiotomies, tears, forceps delivery); 36 patients had a history of anal or perineal surgery; and two patients had perianal Crohn's disease. Nine patients (17 percent) had undergone prior sphincter repair. Incontinence grade improved in 37 patients (71 percent), and complete continence returned in 21 patients (40 percent). The presence of a rectovaginal fistula, postoperative complications, previous sphincter repair, and increase in pudendal nerve terminal motor latency did not affect functional outcome (P = not significant). Patients older than 50 years had a better functional outcome than their younger counterparts after sphincter repair (P=0.02). Although mean maximal squeeze pressure and mean anal sphincter length increased significantly after sphincter reconstruction (P=0.0006 and 0.004, respectively), only squeeze pressure difference correlated with functional outcome (r=0.37;P=0.007). CONCLUSIONS: Overlapping sphincter reconstruction improved anal function in the majority of patients. The most important factor in the return to normal sphincter function is an increase in squeeze pressure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. JAMA 1995;274:33–6.
Hool GR, Lieber ML, Church JM. Postoperative anal canal length predicts outcome in patients having sphincter repair for fecal incontinence. Dis Colon Rectum 1999;42:313–8.
Simmang C, Birnbaum EH, Kodner IJ, Fry RD, Fleshman JW. Anal sphincter reconstruction in the elderly: does advancing age affect outcome? Dis Colon Rectum 1994;37:1065–9.
Fleshman JW, Dreznik Z, Fry RD, Kodner IJ. Anal sphincter repair for obstetric injury: manometric evaluation of functional results. Dis Colon Rectum 1991;34:1061–7.
Fleshman JW, Peters WR, Shemesh EI, Fry RD, Kodner IJ. Anal sphincter reconstruction: anterior overlapping muscle repair. Dis Colon Rectum 1991;34:739–43.
Londono-Schimmer EE, Garcia-Duperly R, Nicholls RJ, Ritchie JK, Hawley PR, Thomson JP. Overlapping anal sphincter repair for faecal incontinence due to sphincter trauma: five year follow-up functional results. Int J Colorectal Dis 1994;9:110–3.
Ternent CA, Shashidharan M, Blatchford GJ, Christensen MA, Thorson AG, Sentovich SM. Transanal ultrasound and anorectal physiology findings affecting continence after sphincteroplasty. Dis Colon Rectum 1997;40:462–7.
Delechenaut P, Leroi AM, Weber J, Touchais JY, Czernichow P, Denis P. Relationship between clinical symptoms of anal incontinence and the results of anorectal manometry. Dis Colon Rectum 1992;35:847–9.
Carty NJ, Moran B, Johnson CD. Anorectal physiology measurements are of no value in clinical practice. True or false? Ann R Coll Surg Engl 1994;76:276–80.
Yee LF, Birnbaum EH, Read TE, Kodner IJ, Fleshman JW. Use of endoanal ultrasound in patients with rectovaginal fistulas. Dis Colon Rectum 1999;42:1057–64.
Browning GG, Parks AG. Postanal repair for neuropathic faecal incontinence: correlation of clinical result and anal canal pressures. Br J Surg 1983;70:101–4.
Young CJ, Mathur MN, Eyers AA, Solomon MJ. Successful overlapping anal sphincter repair: relationship to patient age, neuropathy, and colostomy formation. Dis Colon Rectum 1998;41:344–9.
Malouf AJ, Norton CS, Engel AF, Nicholls RJ, Kamm MA. Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet 2000;355:260–5.
Wexner SD, Marchetti F, Jagelman DG. The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review. Dis Colon Rectum 1991;34:22–30.
Duthie HL, Watts JM. Contribution of the external anal sphincter to the pressure zone in the anal canal. Gut 1965;6:64–8.
Freckner B, Von Euler C. Influence of pudendal block on the anal sphincters. Gut 1975;16:482–9.
Oliveira L, Pfeifer J, Wexner SD. Physiological and clinical outcome of anterior sphincteroplasty. Br J Surg 1996;83:502–5.
Sitzler PJ, Thomson JP. Overlap repair of damaged anal sphincter: a single surgeon's series. Dis Colon Rectum 1996;39:1356–60.
Donnelly V, O'Connell PR, O'Herlihy C. The influence of oestrogen replacement on faecal incontinence in postmenopausal women. Br J Obstet Gynaecol 1997;104:311–5.
Marcello PW, Barrett RC, Coller JA,et al. Fatigue rate index as a new measurement of external sphincter function. Dis Colon Rectum 1998;41:336–43.
Siproudhis L, Bellissant E, Pagenault M,et al. Fecal incontinence with normal and canal pressures: where is the pitfall? Am J Gastroenterol 1999;94:1556–63.
Author information
Authors and Affiliations
About this article
Cite this article
Ha, H.T., Fleshman, J.W., Smith, M. et al. Manometric squeeze pressure difference parallels functional outcome after overlapping sphincter reconstruction. Dis Colon Rectum 44, 655–660 (2001). https://doi.org/10.1007/BF02234561
Issue Date:
DOI: https://doi.org/10.1007/BF02234561