TY - JOUR
T1 - Previous sphincter repair does not affect the outcome of repeat repair
AU - Giordano, Pasquale
AU - Renzi, Adolfo
AU - Efron, Jonathan
AU - Gervaz, Pascal
AU - Weiss, Eric G.
AU - Nogueras, Juan J.
AU - Wexner, Steven D.
N1 - Funding Information:
Supported in part by a generous grant from the Eleanor Naylor Dana Charitable Trust. Presented at the meeting of The American Society of Colon and Rectal Surgeons, San Diego, California, June 2 to 7, 2001. Address reprint requests to Dr. Wexner: 2950 Cleveland Clinic Boulevard, Weston, Florida 33331.
PY - 2002
Y1 - 2002
N2 - PURPOSE: As many as 60 percent of patients present with recurrent symptoms of fecal incontinence after anterior overlapping anal sphincter repair. The aim of this study was to assess the outcome of repeat overlapping anal sphincter repair. METHODS: All female patients with obstetric sphincter damage who underwent anterior overlapping sphincter repair between November 1988 and June 2000 were reviewed. All patients were preoperatively assessed by anorectal manometry, electromyography, and pudendal nerve terminal motor latency; manometry was repeated during follow-up. Preoperative endoanal ultrasonography was available only after 1990. Clinical outcome was assessed according to the Cleveland Clinic Florida Incontinence Score. RESULTS: One hundred fifty,-one patients were available for analysis, 115 without previous surgery and 36 after at least one previous sphincter repair. The median follow-up was 13 (range, 1-64) months and 20 (range, 2-96) months, respectively. The median incontinence score improved from 18 to 5 (P < 0.0001) in patients without previous repair and from 17.5 to 7 (P < 0.0001) in patients after previous repair. In the former group, the outcome was good in 67 (58 percent) patients, adequate in 19 (16.5 percent), and poor in 29 (25.5 percent). In the group with previous sphincter repair, the outcome was good in 18 patients (50 percent), adequate in 4 (11 percent), and poor in 14 (39 percent; P = 0.2646). The mean resting pressure increased from 20 (range, 3-43) mmHg to 24 (range, 10-44) mmHg and from 27 (range, 4-56) mmHg to 32 (range, 16-45) mmHg, respectively. The mean squeeze pressure increased from 60 (range, 23-63) mmHg to 67 (range, 33-114) mmHg and from 54 (range, 25-90) mmHg to 70 (range, 34-95) mmHg, respectively. CONCLUSION: Previous sphincter repair does not affect clinical outcome. Repeat anterior overlapping sphincter repair yields a significant improvement in the continence score and should be considered as the treatment of choice in patients with fecal incontinence who have had previous sphincter repair and residual anterior sphincter damage.
AB - PURPOSE: As many as 60 percent of patients present with recurrent symptoms of fecal incontinence after anterior overlapping anal sphincter repair. The aim of this study was to assess the outcome of repeat overlapping anal sphincter repair. METHODS: All female patients with obstetric sphincter damage who underwent anterior overlapping sphincter repair between November 1988 and June 2000 were reviewed. All patients were preoperatively assessed by anorectal manometry, electromyography, and pudendal nerve terminal motor latency; manometry was repeated during follow-up. Preoperative endoanal ultrasonography was available only after 1990. Clinical outcome was assessed according to the Cleveland Clinic Florida Incontinence Score. RESULTS: One hundred fifty,-one patients were available for analysis, 115 without previous surgery and 36 after at least one previous sphincter repair. The median follow-up was 13 (range, 1-64) months and 20 (range, 2-96) months, respectively. The median incontinence score improved from 18 to 5 (P < 0.0001) in patients without previous repair and from 17.5 to 7 (P < 0.0001) in patients after previous repair. In the former group, the outcome was good in 67 (58 percent) patients, adequate in 19 (16.5 percent), and poor in 29 (25.5 percent). In the group with previous sphincter repair, the outcome was good in 18 patients (50 percent), adequate in 4 (11 percent), and poor in 14 (39 percent; P = 0.2646). The mean resting pressure increased from 20 (range, 3-43) mmHg to 24 (range, 10-44) mmHg and from 27 (range, 4-56) mmHg to 32 (range, 16-45) mmHg, respectively. The mean squeeze pressure increased from 60 (range, 23-63) mmHg to 67 (range, 33-114) mmHg and from 54 (range, 25-90) mmHg to 70 (range, 34-95) mmHg, respectively. CONCLUSION: Previous sphincter repair does not affect clinical outcome. Repeat anterior overlapping sphincter repair yields a significant improvement in the continence score and should be considered as the treatment of choice in patients with fecal incontinence who have had previous sphincter repair and residual anterior sphincter damage.
KW - Fecal incontinence
KW - Incontinence score
KW - Outcome
KW - Overlapping sphincter repair
KW - Repeat sphincter repair
KW - Sphincteroplasty
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U2 - 10.1007/s10350-004-6260-7
DO - 10.1007/s10350-004-6260-7
M3 - Article
C2 - 12004213
AN - SCOPUS:0036256482
VL - 45
SP - 635
EP - 640
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
SN - 0012-3706
IS - 5
ER -