대한대장항문학회

Purpose : We designed this study to evaluate efficacy of sphincter repair and factors<br>influencing in patients with postobstetric fecal incontinence. Methods : Twenty-one patients<br>(mean age 42 years; range 23∼67) undergoing sphincter repair for postobstetric fecal<br>incontinence (mean duration 12 years; range 6 months∼46 years) were evaluated<br>prospectively. Preoperatively, standardized interviews, anorectal manometry and measure<br>ment of pudendal nerve terminal motor latency (PNTML) were performed. Incontinence was<br>graded according to the Parks' classification: Grade 1 - continence to stool and flatus; Grade<br>2 - incontinent to flatus, some urgency to stool present but no incontinence; Grade 3 -<br>incontinent to liquid stool; Grade 4 - incontinent to formed stool. Sphincter repair methods<br>were overlap repair of external anal sphincter (EAS) in 4 patients, overlap repair of EAS with<br>anterior levatorplasty in 15 patients, and overlap repair of EAS with anterior levatorplasty and<br>postanal repair in 2 patients. Anorectal manometry at 3 months, and interviews at 3 months<br>and 6 months after sphincter repair were performed again. Patients' satisfaction was<br>classified as excellent, good, fair, and no improvement. Results : Difficulty in first delivery<br>was noticed in 18 patients and history of previous sphincter repair was noticed in 5 patients.<br>Preoperatively, most patients showed high grade incontinence (grade 3 in 13 and grade 4 in<br>8 patients). After sphincter repair, 18 patients (85.7%) became grade 1 or 2, and 16 patients<br>(76.2%) replied their functional satisfaction excellent or good. There were no difference<br>between the results at 3 months and 6 months. Poor functional outcome was in 2 of 3<br>patients with bilaterally prolonged preoperative PNTML. Short duration of incontinence and<br>young age at the time of repair favored good results. Previous sphincter repair did not<br>influence the outcome. Postoperatively both anal pressure and high pressure zone length were<br>significantly increased in patients with improved continence. Postoperative complications were<br>wound infection in 2 patients and necrosis at the apex of the advancement skin flap in 1 case<br>but these did not influence the outcome. Conclusions : Most postobstetric fecal incontinence<br>can be successfully treated with sphincter repair. Excellent results are expected when the<br>duration of incontinence is short and the patients are young. Pudendal neuropathy seemed to<br>be related to poor outcome.<br>