Reconstruction of Anal Sphincters Following Fecal Incontinence and Assessment of Functional Results
Authors:
P. Šlauf; P. Bartoška; O. Ryska; F. Antoš
Authors‘ workplace:
Chirurgická klinika IPVZ a 1. LF UK, FN Na Bulovce, Praha, přednosta: prof. MUDr. F. Antoš, CSc.
Published in:
Rozhl. Chir., 2008, roč. 87, č. 8, s. 426-431.
Category:
Monothematic special - Original
Overview
The aim of the study was to assess functional results of surgical sphincter reconstructions for anal incontinence. From August 1999 to January 2007, 52 patients (females 50, males 2), 45 y.o.a. on average (24–69), underwent secondary anal sphincters reconstructions for fecal incontinence, resulting from birth injuries, event. in combination with sphincter weakening in pudendal neurophathy, or for post- anorectal surgery incontinence. Duration of the incontinence symptoms prior to the surgery was 2 months to 19 years. The overlap technique in combination with anterior levatorplasty was used in most subjects (n = 31). In 12 subjects, anterior sphincters and levators plication was performed. Four patients underwent overlap reconstructions only and five patients underwent complete sphincter reconstructions. Protective colostomy was performed in six patients. Six patients underwent additional postoperative biofeedback. Endoanal ultrasound was performed in all patients prior to their procedures. Terminal motor latency examination of the pudendal nerve was indicated in all patients with sphincter dysfunction without localized defects. Anal manometry was recorded prior and post- operatively. Incontinence was assessed using the St. Mark‘s incontinence score (0–13). The patients assessed the reconstruction results based on the Likert scale.The reconstruction was successfull in 46 patients (88.5 %), full continence was recovered in 20 (38.5 %) patients and improvement of incontinence was recorded in 26 (50 %) subjects. In six subjects (11.5 %), the reconstruction failed. The mean incontinence score reduction following the procedure was from11.8 to 2.4. The short- term sphincter reconstruction results were successful in the majority of the subjects, the long- term results will be assessed in another study.
Key words:
anal sphincters – incontinence – surgical management – functional results
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Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2008 Issue 8
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