Overlapping Repair in Patients with Anal Sphincter Injury

Abstract

Objective: The aim of this study was to demonstrate the improvement of anal canal function after overlap sphincter repair and confirm that this treatment option is superior in patients with nonobstetric sphincter damage. Subjects and Methods: From 1998 to 2003, 44 women who underwent overlapping sphincter repair were enrolled in this study. The women were allocated to one of two groups, obstetric trauma (n = 31) and nonobstetric (perineal) trauma (n = 13). Both groups were compared in terms of age, operation time, number of deliveries, hospital stay, need for analgesics, complication rate, pre- and postoperative outcomes of anal manometry and quality of life, using the fecal incontinence severity index and a questionnaire for fecal disorders. Results: Anal canal length was significantly extended postoperatively in both groups compared to preoperative length. Eight-week postoperative resting and squeeze pressures were significantly higher than preoperative pressures in both patients with nonobstetric and obstetric sphincter injury. Although significant increase was seen in both groups, the mean postoperative resting and squeeze pressures at 1 year were rather high in patients with nonobstetric sphincter injury. At the end of a year of follow-up, overall satisfaction of the repair was about 82%. Conclusion: Overlap sphincter repair was feasible, although patient satisfaction was slightly less in the obstetric than in the nonobstetric trauma group. The improvement of anal function at 20- to 24-month follow-up is attributed to both high squeeze pressure and broad anal canal.

Anal sphincter repair for fecal incontinence: experience from a tertiary care centre

“…Of these six had presented after road traffic accidents and had undergone a delayed repair (mean 4.6 [2][3][4][5][6][7][8] months); of these, two had undergone augmentation graciloplasty and all had a diversion colostomy. The other two patients had undergone sphincter repair immediately after a bull gore injury.…”

“…It is often secondary to structural defects in the anal sphincter, with obstetric anal sphincter injury being the commonest cause [3]. Other causes include perineal trauma and iatrogenic injuries after perineal surgery [3]. Overlap sphincteroplasty has been widely used in the treatment for these cases.…”

Outcomes of Anal Sphincter Injury Repair; Minia University Hospital Experience Prospective Study

“…However, long-term results (69-120 months) have shown success rates ranging from 14 to 80 percent [10] .This lower success rates may be attributed to aging with associated striated muscle atrophy or may be due to the occult coexistence of anatomical defects of the pelvic floor [11] . In obstetric lesions; the Outcomes of Anal Sphincter Injury Repair; Minia University Hospital Experience Prospective Study primary repair of sphincteric injuries, which detected at delivery, by suitably trained surgeon decreases the associated morbidity [12] . This study was designed to determine short and long-term outcomes in patients with FI.…”

IIIB-IV Degree Perineal Rupture Repair Using Overlapping and End-to-End Techniques with Pudendal Block Anesthesia

“…Local anesthesia (infiltration or pudendal block) can be used on almost all measures of perineal repair, although general or regional anesthesia produces better sphincter relaxation. 3,7,9,[21][22][23] Evaluation on results of repair is performed at weeks 1, 2, 6, and 3 months after repair. Complaints to be evaluated are complaints related to suturing, possibility of infection up to dehiscence, impaired urination, defecation and dyspareunia.…”

“…5 Evaluation in the third month can be done using ultrasonography, anal manometry, electromyography, measurement of pudendal nerve terminal latency time, and magnetic resonance imaging (MRI). 21,[24][25][26][27] Pudendal nerves are somatic nerves found in the pelvic region that innervate the external genitalia in both men and women. These nerves originate from the sacral plexus, from the S2 to S4 ventral rami.…”