대한대장항문학회

Purpose : Fecal incontinence is a disabling condition with devastating psychosocial due<br>to diverse etiology. This study was performed to assess various causes of fecal<br>incontinence, clinical evaluation, and adequate surgical treatment. Methods : Eighty<br>patients presenting fecal incontinence during July 1989 and June 1997 were included.<br>They were evaluated by clinical parameters and physiologic tests including the<br>defecography, electromyography, transanal ultrasonography, and anorectal manometry.<br>Surgery was performed in 31 patients based on those evaluation. Pre- and<br>post-operative comparison of manometric finding, clinical assessment, incontinence score,<br>and the outcome of surgery were assessed. Mean postoperative follow-up was 22 (2∼<br>84) months. Result: Inappropriate anal surgery was the most common cause, and then<br>injuries during delivery, trauma, rectal prolapse, and hysterectomy in descending order.<br>Defecography was performed in 21 patients and mean values of anorectal angles were<br>115 15°at rest, 98 18°during squeezing, and 136 10°during push. Electromyography<br>was performed in 8 patients showing pudendal neuropathy in 2, bilateral lumbosacral<br>polyradiculopathy in 4, and normal finding in 2 patients, respectively. Transanal<br>ultrasonography was performed in 33 patients and 22 among them showed finding of an<br>injury of the anal sphincters. Surgery was performed in 31 patients due to anal<br>sphincter damage, rectovaginal fistula, and anal stricture in descending order. Type of<br>surgery was determined by respective cause: plication, triple repair (sphincteroplasty,<br>anoplasty, perineorrhaphy), and posterior rectopexy in descending order. Nerve preserving<br>graciloplasty performed in a 12 year-old girl who had severe defect of the anal<br>sphincters by traffic accident, showing sound recovery with a good functional outcome.<br>Although there was no significant difference of manometric variables between pre-and<br>post-operative periods, sphincter length, and maximum resting and squeezing pressure,<br>revealed an increasing tendency postoperatively. According to the clinical assessment<br>between pre- and post-operative periods, urgency to evacuate, soiling, sensation on<br>defecation, and quality discrimination were significantly improved postoperatively<br>(p<0.01). Incontinence score was markedly decreased from 10.6 6.1 during preoperative<br>period 2.9 4.7 during postoperative period (p<0.01). Eighty one percent of the patients<br>undergone surgery experienced a significant symptomatic improvement. Conclusions<br>:According to the analysis of the cause of fecal incontinence, inappropriate anal surgery,<br>injuries during delivery, and trauma were main cause. Adequate application of<br>physiologic tests, such as, defecography, electromyography, transanal ultrasonography,<br>and anorectal manometry, were helpful in determining treatment modality and types<br>surgery. We got satisfactory results with adequate surgery based on the physiologic<br>tests.<br>