Overlap repair of damaged anal sphincter : A single surgeon's series

PURPOSE : This study was undertaken to review consecutive cases of anal sphincter repair performed by a single surgeon with respect to outcome as measured by continence grade using the Parks-Browning scale. Other parameters such as manometry, pudendal nerve function, and morbidity are also reviewed with respect to outcome. METHODS : Thirty-one of 52 patients identified by computer were available for analysis. Case notes were retrieved, and information was transferred into a standard proforma. Minimum follow-up was one month, and continence grade was documented from clinical notes recorded at follow-up. Statistical analysis was performed using Instat computer package. RESULTS : Four patients were male, 27 were female. Average age was 41.9 years. There was no postoperative mortality ; postoperative morbidity was 32 percent in total, but morbidity per procedure was 19.6 percent. Most (20 of 31) patients had a clear obstetric-related cause of their anal sphincter injury. Successful outcome was achieved in 74.2 percent of patients. Postoperative anal manometry was not discriminatory between successful and failed groups. Anal ultrasound appeared accurate in documenting residual anal sphincter defects in the poor outcome group in the small number of patients in whom it was done. Use of a stoma in covering the anal wound while it healed was associated with less infection of the wound, but there was no statistical difference in success rate between those covered by a stoma and those not covered. CONCLUSIONS : Overlap repair of the damaged anal sphincter continues to give good results. Routine use of covering stomas is not supported in this small study ; however, it should still be considered in difficult cases. Endoanal ultrasound may have the ability to identify those patients with poor results from an initial repair who may benefit from repeat repair.