Long-Term Anorectal and Sexual Function After Overlapping Anterior Anal Sphincter Repair: A Case-Match Study

PURPOSE: The purpose of this study was to assess the impact of overlapping anal sphincter repair for fecal incontinence on overall pelvic organ function. METHODS: This study was a case-match study of 25 women undergoing overlapping anal sphincter repair from 1996 through 2003. Functional outcome was assessed using validated scoring systems. For each case, two controls matched for age and parity were assessed. RESULTS: Twenty-one patients responded to the questionnaires; mean follow-up time was 105 (SD, 33.6) months. Analyzing the Wexner incontinence score, the group median improved from 15 (range, 4―20) before the procedure to 8 (range, 2-18; P < 0.001) at follow-up. Conversely, postoperatively there was no difference in symptoms of urinary incontinence between groups. The Female Sexual Function Index of case patients was significantly lower than that of control patients (cases, 16.2 [2.3-33.6]; controls, 26.1 [3.3-36]; P = 0.004). The Short-Form-12 physical health score was similar for both groups (mean ± standard deviation: cases, 46.1 ± 10.8; controls, 48.6 ± 11.4; P = 0.220), whereas the mental health score of patients was significantly lower than that of controls (cases, 39.8 ± 10.5; controls, 47.1 ± 8.5; P = 0.0057). CONCLUSION: Anal sphincter repair for localized sphincter defects may achieve excellent/good long-term functional results in 67 percent of patients, as judged by patients. Despite repair, continence remained significantly inferior in patients as compared with healthy control subjects. In addition, sexual function was significantly diminished in patients as compared with controls, but no correlation with the severity of fecal incontinence was found.