Long-term follow-up after anterior sphincter repair: influence of age on functional outcome.

AIM: Anterior sphincter repair has been advocated for women with anterior sphincter defects and faecal incontinence. There have been a number of reports of deterioration in functional outcome from anal sphincter repair over the long-term and of inferior outcomes in older patients. This study set out to examine these issues in a specialist tertiary referral unit.

METHOD: Patients having a sphincter repair were identified from a prospectively collected database. The information within the database was expanded by the use of a postal questionnaire and structured review of the case notes. The questionnaire incorporated commonly used validated scoring systems as well as subjective questions.

RESULTS

One hundred and thirteen patients were identified, of whom 66 (58%) responded. Of these patients, four had incomplete medical notes, leaving 62 (55%) with both returned questionnaires and complete medical notes. Forty-eight (72%) patients reported subjective initial improvement in their symptoms, though only 37 (56%) believed themselves improved at long-term follow-up (median 8.8 years; range 1.1-13.6 years). Incontinence and quality of life scores mirrored these patients' subjective responses. The median age of those patients reporting a subjective improvement at long-term follow-up was 38, compared with 56 in those who thought they were not improved (P < 0.001).

CONCLUSIONS

Outcome from anal sphincter repair deteriorates with time. Subjective outcome is worse in older patients who additionally tend to have worse incontinence scores and quality of life measures.