Anal sphincter reconstruction for incontinence due to non-obstetric sphincter damage.

OBJECTIVE

To assess the outcome after anal sphincteroplasty in patients with anal incontinence following non-obstetric anal sphincter damage.

DESIGN

A prospective study carried out in an urban teaching hospital over five years (1994-1998).

PATIENTS AND

METHODS

Fourteen patients, median age of 30 years, all undergoing anal sphincter reconstruction. The procedure was performed under general or regional anaesthesia. Operative management was (i) excision of the scar tissue and apposition of the cut ends of the sphincter or (ii) a reefing technique.

RESULTS

Sphincter damage was as a result of trauma in nine cases, haemorrhoidectomy in two cases, sepsis in two and failed recto-vaginal fistula repair in one case. In six patients with traumatic sphincter damage a colostomy was performed at original operation. The other eight presented with incontinence, four of whom required a diverting colostomy prior to repair. The median delay between sphincter injury and repair was six months (range 4-120). The posterior approach was used in eight patients, an anterior approach in five and both approaches in one. Non-absorbable suture material was used in six and absorbable material was used in eight patients. Twelve of the 14 patients had scar tissue at the site of damage requiring excision. Two post-haemorrhoidectomy patients underwent the reefing technique. Eleven patients (79%) were completely continent after initial repair. Two required further repair resulting in complete continence. One patient remained with mild incontinence.

CONCLUSION

Anal sphincter reconstruction for non-obstetric anal incontinence produced good short-term results.