Neuropathic faecal incontinence is associated with low anal pressures and shortening of the anal canal. The operation of postanal repair has been shown to result in the return of acceptable continence in over 80 per cent of such patients. This paper examines the effect of the operation on anal canal pressures. Forty-two patients with primary faecal incontinence and electrophysiological evidence of neuropathy affecting the external anal sphincter and pelvic floor musculature were studied. Anal pressures were measured before operation and not less than 1 month afterwards. Two groups were chosen according to the clinical result. Group 1 consisted of 34 patients who regained continence and group 2 comprised 8 patients judged as having had an unsatisfactory result. In group 1 there was an increase in anal canal length (1.4 +/- 0.2 cm, mean +/- s.e.m., paired t test, P less than 0.001), resting pressure (19 +/- 3 cm H2O, P less than 0.001) and voluntary contraction pressure (13 +/- 3 cm H2O, P less than 0.001). In group 2 there was some increase in anal canal length (1.0 +/- 0.2 cm P less than 0.01) but no increase in mean resting pressure or mean voluntary contraction pressure. The results show that postanal repair effectively lengthens the anal canal and increases anal pressures in patients with a successful clinical outcome.
The surgical management of a consecutive series of 97 patients with complete division of the anal sphincter musculature is reported. The sphincter damage followed operative, traumatic, or obstetric injury and resulted in frank fecal incontinence or the urgent necessity of a defunctioning colostomy. All patients were treated by delayed sphincter repair using an overlapping technique; in 93 the repair was protected by a temporary defunctioning stoma. There were no deaths. The repair was completely successful in 65 (78%) and partially successful in 11 (13%) of the 83 patients assessed from 4 to 116 months after surgery. Complications occurred in 27 patients but did not usually affect the eventual clinical outcome. Provided there has been no major neurological damage to the sphincter complex, surgical reconstruction can be expected to restore continence in most patients.
Parks operation for faecal incontinence was performed on 97 patients with total loss of anorectal control due to injury. All had sustained complete division of the anal sphincters as a result of trauma, anal surgery, or obstetric tears and either were incontinent or had been given a colostomy. In all patients the divided sphincters were repaired using an overlapping technique; in 93 the repair was protected by a temporary defunctioning stoma.There was no operative mortality.
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