PURPOSEcolon;Patients with idiopathic or neurogenic incontinence without an isolated sphincter defect may be suitable candidates for a postanal repiar. The aim of this study was to assess the results of postanal repair in patients with idiopathic or neurogenic fecal incontinence and to evaluate the role of various parameters, including preoperative physiologic testing on outcome.METHODScolon;Postanal repair was offered by a single surgeon to patients meeting the following criteriacolon; incontinence score of at least 12 of 20, absence of an isolated anterior external anal sphincter defect, and failed conservative, medical, and biofeedback management. Physiologic investigation and clinical findings of female patients who had postanal repair for fecal incontinence between 1992 and 1998 were reviewed. Physiologic investigation included anorectal manometry, pudendal nerve terminal motor latency, concentric needle electromyography, and endoanal ultrasonography. Followhyphen;up was obtained by telephone questionnairesemi; moreover, patients were asked to grade the outcome of their surgery as excellent or good lpar;successrpar; or as fair or poor lpar;failurerpar;.RESULTScolon;Twentyhyphen;one patients of median age 68 lpar;range, 40hyphen;80rpar; years had a mean duration of fecal incontinence before postanal repair of 6.8 lpar;range, 0.5hyphen;22rpar; years. Twenty patients lpar;95 percentrpar; were available for at least one year of followhyphen;up. Seventeen patients lpar;80.9 percentrpar; had at least one prior vaginal delivery, and prior sphincteroplasty had been performed in 10 patients lpar;47.6 percentrpar;. The morbidity and mortality rates were 5 and 0 percent, respectively. After a mean followhyphen;up period of three lpar;range, 1hyphen;7.5rpar; years, seven patients lpar;35 percentrpar; considered surgery to be successful and had a statistically significant decrease in their incontinence score. Neither prolongation of pudendal nerve terminal motor latency nor external sphincter damage as noted on electromyography or any of the preoperative manometric parameters correlated with outcome. Furthermore, patients' ages at surgery did not correlate with the degree of postoperative improvement in continence scores nor did the duration of the patients' symptoms, number of vaginal deliveries, or a history of previous surgery for fecal incontinence.CONCLUSIONcolon;None of the factors assessed was demonstrated to be predictive of outcome after postanal repairsemi; moreover, the currently available preoperative testing has not altered the success rate, which remains low lpar;35 percentrpar;. Despite the low success rate, the absence of any mortality and the low morbidity suggest that postanal repair may be a valid therapeutic approach. However, it should be offered only to selected patients with persistent, severe fecal incontinence despite an anatomically intact external anal sphincter who are not candidates for or refuse all other operative modalities.
展开▼
