Physiological and clinical outcome of anterior sphincteroplasty

Abstract

A total of 55 women underwent sphincteroplasty for the treatment of faecal incontinence related to anterior defects. Patients were followed prospectively for a mean of 29 months to evaluate the outcome overall and according to age. All patients were evaluated clinically by means of a questionnaire and graded using an incontinence scoring system ranging from 0 (perfect continence) to 20 (complete incontinence). Some 52 patients (95 per cent) had had a previous vaginal delivery and 30 (55 per cent) had a history of previous anal sphincter repair. Physiological and functional parameters in patients with a successful outcome (n = 39) were compared with those in patients with a poor outcome (n = 16). The results were also compared in patients under (n = 39) and over (n = 16) 60 years of age. Overall, patients with a successful outcome had a significant change in mean and maximal resting and squeeze pressures. These changes correlated well with the increase in the high-pressure zone (HPZ) length from 1.0-2.2 cm (P = 0.0002) and with functional outcome (change in incontinence score from 15.3 to 5.8; P < 0.0001). In patients over 60 years of age, a significant change in mean squeeze pressure (P = 0.03) and HPZ length (P = 0.01) was noted and correlated with functional outcome (change in incontinence score from 14.3 to 6.4; P < 0.0001). A successful outcome after anterior sphincteroplasty is related to improvement in sphincter function even in an older population. These results demonstrate that age itself does not seem to be a predictor of poor outcome. Patients should not be denied a repair exclusively on grounds of age.

Long-Term Functional Outcome After Stapled and Excisional Hemorrhoidectomy

“…1) Short form 36 Version 2 (SF-36v2) (8) 2) Wexner continence score questionnaire and (9,10) 3) Presence of anal symptoms.…”

Transplante anorretal como proposta terapêutica para o tratamento de incontinência fecal e colostomia definitiva

“…No entanto, alguns autores mostraram em estudos randomizados que os resultados das duas técnicas são semelhantes 47 . A maioria das séries de reparação anterior do esfíncter incluem pacientes com defeitos devido a causas não-obstétricas, tais como fistulotomia, com resultados imediatos variando entre 70-80% 48,49 . Medidas de constipação ou uso de laxativos no pós-operatório e colostomia de proteção não parecem influenciar nos resultados da cirurgia [50][51][52] .…”

“…Por outro lado, o tempo médio de latência do nervo pudendo (TMLNP) prolongado, comumente associado a lesão direta do nervo pudendo e ao trauma por estiramento relacionado ao parto, parece ser um preditor de resultado funcional precário. Em conjunto com outros fatores, como tentativas anteriores de reparação esfincteriana e tempo de duração dos sintomas pré-operatórios, pode influenciar na taxa de sucesso 48,53,54 . Dois fatores importantes associados ao insucesso da esfincteroplastia são a infecção do sítio cirúrgico, que pode ocorrer em até 24% dos casos, e a abertura da incisão após o reparo inicial, que chega a 10% 55 .…”

Outcomes of electrically stimulated gracilis neosphincter surgery

“…The Cleveland Clinic score, 44 which is a quantifying measurement of symptoms, is widely used in assessing FI, although it has been superseded since the start of this study. It arbitrarily imposes a scoring system which equates the burden of incontinence to solid stool to that of incontinence to flatus, or the need to wear pads or an inability to carry out usual activities.…”

“…G Cleveland Clinic FI scale, together with frequency of incontinence to solid or liquid stool. 44 (The Cleveland Clinic Incontinence Score includes questions regarding incontinence to solid and liquid stool, incontinence to flatus, use of pads and ability to perform usual activities. It gives scores of between zero and four according to frequency for each item, 20 being the worst possible score.…”