Sphincteroplasty with separate suturing of the internal sphincter results in continence for stools maintained for at least three years among the majority of the patients and an improvement of anal continence in nearly two-thirds of the patients, according to researchers from Innlandet Hospital Trust Hamar and the University of Oslo, Norway.
The paper, ‘Long-term outcome of sphincteroplasty with separate suturing of the internal and the external anal sphincter’, published in Techniques in Coloproctology, sought to evaluate the long-term effect of sphincteroplasty with separate suturing of the internal and the external anal sphincter on anal continence.
In total, 94 participants were included in the analysis - 78 had endoanal ultrasound and clinical examination. Patients’ demographics were collected and the researchers utilised the St Mark’s score to measure anal incontinence.
The investigators report that the St Mark’s score improved by a median of 4.5 points at a median follow-up of 44.5 months (range 25–84 months). The median pre-operative score was 13 points and showed a statistically significant improvement to 6.5 points at long-term follow-up (p < 0.001). Forty-seven (50%) patients reported an improvement of at least five points compared with the pre-operative St. Mark’s scores and 60 participants experienced an improvement in anal continence by at least three points. The authors reported that post-operative wound infection was the most common complication and occurred in 27 of the 94 participants (28.7%).
Regarding leakage, the authors reported that:
- Daily leakage of flatus occurred in 32 participants (34.0%) at long-term follow-up
- Faecal leakage was experienced daily by six participants (6.4%)
- Weekly Faecal leakage was experience by 14 participants (14.9%)
- Fecal urgency persisted in 37 participants (39.4%)
There were no significant differences in the long-term outcome between the 15 participants operated on twice (mean reduction 4.4 points) and the 79 participants (mean reduction 4.7 points) operated on once (p=0.68).
The authors cautioned that “secondary sphincteroplasty should not be offered to patients with low degrees of anal incontinence unless the purpose of the surgery is to alleviate other symptoms such as impaired sexual function due to abnormal anatomy.” They also noted that patients should be informed that anal incontinence could deteriorate post-operatively if their pre-operative St Mark’s score was low.
“In our opinion, sphincteroplasty should have a role in the treatment of anal incontinence after obstetric anal sphincter injuries,” the authors concluded. “Adequate patient selection is important to achieve good outcomes, and annual follow-up for the first few years postoperatively is important to ensure patients with suboptimal outcomes get access to other treatment options.”
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