대한대장항문학회

<b>Purpose:</b> To assess the outcome of complete anatomical repair (sphincteroplasty, rectal wall plication, rectovaginal septum plication, perineal body repair, levatoroplasty) and to identify the preoperative factors influencing the outcome<br>for<br>the<br>perineal obstetric injury.<br><br><b>Methods:</b> Eighteen, consecutive female patients who had undergone complete anatomical repair with chronic fecal incontinence due to perineal injury during 13 months were evaluated. Mean age was 48.9±10.1 years, mean duration of symptom was<br>18.9<br>(range: 1∼33) years, mean delivery numbers were 2.8±1.2 times, and mean follow up was 11.9±4.7 months. The predictive factors were age, manometry, PNTML (pudendal nerve terminal motor latency), rectal sensation, RAIR (rectoanal inhibitory<br>reflex),<br>duration of symptom, angle of sphincter defect, vaginal delivery numbers, hospital stay, follow-up period, wound healing period, and Wexner's incontinence score.<br><br><b>Results:</b> The anatomical success rate via endoanal ultrasonography was 100%, complication rate was 5.5%, and functional success rate (Wexners' score≤5) was 88.9%. The patients showed lower maximal resting pressure, maximal squeezing<br>pressure,<br>maximal voluntary contraction, mean resting pressure, mean squeezing pressure, and maximal tolerable volume than the normal control group (P＜0.05). The median incontinence score was significantly decreased after surgery (pre op=12.2 vs post<br>op=2.9)<br>(P＜0.05). Among the preoperative predictive factors, the incontinence score correlated significantly with postoperative functional success (r=0.552, P=0.017).<br><br><b>Conclusions:</b> Complete anatomical repair showed an excellent anatomical result and a good functional outcome. Patient with high preoperative incontinence score had a tendency for postoperative residual incontinence.<br>