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Postanal repair for fecal incontinence--is it worthwhile?
Dis Colon Rectum. 2000 Nov; 43(11):1561-7.DC

Abstract

PURPOSE

Patients with idiopathic or neurogenic incontinence without an isolated sphincter defect may be suitable candidates for a postanal repair. The aim of this study was to assess the results of postanal repair in patients with idiopathic or neurogenic fecal incontinence and to evaluate the role of various parameters, including preoperative physiologic testing on outcome.

METHODS

Postanal repair was offered by a single surgeon to patients meeting the following criteria: incontinence score of at least 12 of 20, absence of an isolated anterior external anal sphincter defect, and failed conservative, medical, and biofeedback management. Physiologic investigation and clinical findings of female patients who had postanal repair for fecal incontinence between 1992 and 1998 were reviewed. Physiologic investigation included anorectal manometry, pudendal nerve terminal motor latency, concentric needle electromyography, and endoanal ultrasonography. Follow-up was obtained by telephone questionnaire; moreover, patients were asked to grade the outcome of their surgery as excellent or good (success) or as fair or poor (failure).

RESULTS

Twenty-one patients of median age 68 (range, 40-80) years had a mean duration of fecal incontinence before postanal repair of 6.8 (range, 0.5-22) years. Twenty patients (95 percent) were available for at least one year of follow-up. Seventeen patients (80.9 percent) had at least one prior vaginal delivery, and prior sphincteroplasty had been performed in 10 patients (47.6 percent). The morbidity and mortality rates were 5 and 0 percent, respectively. After a mean follow-up period of three (range, 1-7.5) years, seven patients (35 percent) considered surgery to be successful and had a statistically significant decrease in their incontinence score. Neither prolongation of pudendal nerve terminal motor latency nor external sphincter damage as noted on electromyography or any of the preoperative manometric parameters correlated with outcome. Furthermore, patients' ages at surgery did not correlate with the degree of postoperative improvement in continence scores nor did the duration of the patients' symptoms, number of vaginal deliveries, or a history of previous surgery for fecal incontinence.

CONCLUSION

None of the factors assessed was demonstrated to be predictive of outcome after postanal repair; moreover, the currently available preoperative testing has not altered the success rate, which remains low (35 percent). Despite the low success rate, the absence of any mortality and the low morbidity suggest that postanal repair may be a valid therapeutic approach. However, it should be offered only to selected patients with persistent, severe fecal incontinence despite an anatomically intact external anal sphincter who are not candidates for or refuse all other operative modalities.

Authors+Show Affiliations

Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11089593

Citation

Matsuoka, H, et al. "Postanal Repair for Fecal Incontinence--is It Worthwhile?" Diseases of the Colon and Rectum, vol. 43, no. 11, 2000, pp. 1561-7.
Matsuoka H, Mavrantonis C, Wexner SD, et al. Postanal repair for fecal incontinence--is it worthwhile? Dis Colon Rectum. 2000;43(11):1561-7.
Matsuoka, H., Mavrantonis, C., Wexner, S. D., Oliveira, L., Gilliland, R., & Pikarsky, A. (2000). Postanal repair for fecal incontinence--is it worthwhile? Diseases of the Colon and Rectum, 43(11), 1561-7.
Matsuoka H, et al. Postanal Repair for Fecal Incontinence--is It Worthwhile. Dis Colon Rectum. 2000;43(11):1561-7. PubMed PMID: 11089593.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postanal repair for fecal incontinence--is it worthwhile? AU - Matsuoka,H, AU - Mavrantonis,C, AU - Wexner,S D, AU - Oliveira,L, AU - Gilliland,R, AU - Pikarsky,A, PY - 2000/11/23/pubmed PY - 2001/2/28/medline PY - 2000/11/23/entrez SP - 1561 EP - 7 JF - Diseases of the colon and rectum JO - Dis Colon Rectum VL - 43 IS - 11 N2 - PURPOSE: Patients with idiopathic or neurogenic incontinence without an isolated sphincter defect may be suitable candidates for a postanal repair. The aim of this study was to assess the results of postanal repair in patients with idiopathic or neurogenic fecal incontinence and to evaluate the role of various parameters, including preoperative physiologic testing on outcome. METHODS: Postanal repair was offered by a single surgeon to patients meeting the following criteria: incontinence score of at least 12 of 20, absence of an isolated anterior external anal sphincter defect, and failed conservative, medical, and biofeedback management. Physiologic investigation and clinical findings of female patients who had postanal repair for fecal incontinence between 1992 and 1998 were reviewed. Physiologic investigation included anorectal manometry, pudendal nerve terminal motor latency, concentric needle electromyography, and endoanal ultrasonography. Follow-up was obtained by telephone questionnaire; moreover, patients were asked to grade the outcome of their surgery as excellent or good (success) or as fair or poor (failure). RESULTS: Twenty-one patients of median age 68 (range, 40-80) years had a mean duration of fecal incontinence before postanal repair of 6.8 (range, 0.5-22) years. Twenty patients (95 percent) were available for at least one year of follow-up. Seventeen patients (80.9 percent) had at least one prior vaginal delivery, and prior sphincteroplasty had been performed in 10 patients (47.6 percent). The morbidity and mortality rates were 5 and 0 percent, respectively. After a mean follow-up period of three (range, 1-7.5) years, seven patients (35 percent) considered surgery to be successful and had a statistically significant decrease in their incontinence score. Neither prolongation of pudendal nerve terminal motor latency nor external sphincter damage as noted on electromyography or any of the preoperative manometric parameters correlated with outcome. Furthermore, patients' ages at surgery did not correlate with the degree of postoperative improvement in continence scores nor did the duration of the patients' symptoms, number of vaginal deliveries, or a history of previous surgery for fecal incontinence. CONCLUSION: None of the factors assessed was demonstrated to be predictive of outcome after postanal repair; moreover, the currently available preoperative testing has not altered the success rate, which remains low (35 percent). Despite the low success rate, the absence of any mortality and the low morbidity suggest that postanal repair may be a valid therapeutic approach. However, it should be offered only to selected patients with persistent, severe fecal incontinence despite an anatomically intact external anal sphincter who are not candidates for or refuse all other operative modalities. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/11089593/Postanal_repair_for_fecal_incontinence__is_it_worthwhile L2 - http://link.springer.com/article/10.1007/BF02236739 DB - PRIME DP - Unbound Medicine ER -