Audit of sphincter repair. Factors associated with poor outcome.

PURPOSE: This study was designed to critically analyze the outcome of sphincter repair and, if possible, to identify high-risk factors.

METHODS

Clinical and physiologic assessment was made of all sphincter repairs (42 patients) performed in one unit by two surgeons during five years.

RESULTS

Forty-two patients (10 men, 32 women) underwent sphincter repair. Only three of five men with anterior defects of the anorectum from perineal trauma were rendered continent. Only three of five men with defects from fistula operations became continent, but one improved by later graciloplasty. All six women with fistula-related injuries eventually achieved continence, but two required repeat sphincter repairs because of early breakdown from sepsis. The worst results were in 26 women with third-degree obstetric injuries, of whom 11 remain incontinent; poor results in this group were associated with gross perineal descent, obesity, and age older than 50 years; two or more of these factors indicated a poor outcome. Preoperative anorectal physiology did not identify a poor-risk group.

CONCLUSIONS

Poor results were identified in women with anterior defects from obstetric trauma, especially if they were obese, older than 50 years of age, and had perineal descent.