Anterior anal sphincter repair in patients with obstetric trauma

TLDR

Anterior sphincter repair was performed on 55 obstetric trauma patients (32 immediate, 23 late onset), with pre‑ and postoperative anal endosonography and physiological testing. At a median 15‑month follow‑up, 42 of 55 patients improved (11 unchanged, 2 awaiting colostomy), with postoperative squeeze pressure rising by 20 cm H₂O, a higher rate of intact external sphincter in those with good outcomes, and failure linked to persistent external sphincter defects, while late‑onset incontinence did not preclude a favorable result.

Abstract

Abstract Anterior sphincter repair for faecal incontinence related to obstetric trauma was performed in 55 patients: 32 with incontinence after delivery and 23 with late onset. Anal endosonography and physiological tests were performed before and after surgery. After a median of 15 (range 6–36) months, 42 patients had improved, 11 had not improved and two were awaiting colostomy closure. The postoperative squeeze pressure was increased (by 20 versus 5 cmH2O, P = 0·05) and the external sphincter was more frequently intact (32 of 35 versus five of 11, P = 0·003) in those with a good outcome. Patients with an intact external sphincter had higher postoperative squeeze pressures (50 versus 20 cmH2O, P = 0·004). Patients with late-onset incontinence were older than those who developed incontinence soon after delivery (median 59 versus 32 years, P < 0·001) and had longer pudendal nerve terminal motor latencies (2·3 versus 2·2 ms, P = 0·03). Failure of repair is related to persistent external sphincter defects. Late-onset incontinence, even with a prolonged pudendal nerve terminal motor latency, does not preclude a good outcome.