Long-Term Results of Overlapping Anterior Anal-Sphincter Repair for Obstetric Trauma

Abstract

As many as one-third of women suffer damage to the anterior part of the anal sphincter at the time of their first vaginal delivery, and perhaps a third of these have new bowel symptoms. This is one of the most common causes of fecal incontinence. This study examined the long-term outcome in 55 consecutive women who were followed for at least 5 years and for a median of 6.5 years after anterior overlapping anal sphincter repair. Thirty-two of them underwent repair shortly after delivery, and the other 23 underwent repair in middle age. Seven of the 46 evaluable patients (15 percent) had required additional surgery for fecal incontinence, and there was one outright failure. Of the remaining 38 patients, 27 (71 percent) reported improved bowel control, 23 of them by at least 50 percent when rating their symptoms on a scale of 0 to 10. Five others had not improved, and six reported that their condition had deteriorated. None of the patients were fully continent when last evaluated, but six had no fecal urgency, and eight were free of soiling. Twenty-five of the 38 patients found that their symptoms restricted their lifestyle to some extent. Patient self-ratings of improvement a median of 15 months after surgery predicted long-term outcome.

These findings suggest that the results of overlapping anal sphincter repair performed in women with obstetric damage deteriorate over time. Patients should know preoperatively that although they are likely to improve to some degree, perfect continence is rare and new evacuation problems are a possibility. Many of these patients will be satisfied by even slight improvement in their symptoms.

Lancet 2000;355:260–265