New techniques in the repair of anal sphincter between success and failure

Abstract

Background: Fecal incontinence is a frequent and debilitating condition that may result from a multitude of different causes. It is defined as the uncontrolled passage of feces or gas over at least 1 month’s duration, in an individual of at least 4 years of age, who had previously achieved control. Aim of Work: to evaluate the outcome of overlap anal sphincter repair and value of this technique in our patients and demonstrate the improvement of the anal canal function after this technique. Patients and Methods: this randomized prospective clinical trial was conducted on thirty (30) patients presented to Ain-Shams University hospitals with anal sphincter injury that were operated upon by a modified overlap repair. Endoanal ultrasonography and anorectal manommetric studies were done and Wexner continence score was estimated for all cases preoperatively and postoperatively. All patients sharing in the study was fully informed about the procedure they had with a written informed consent. Results: In this study the mean preoperative Wexner score was 12.9 and the mean postoperative Wexner was 4.8; this reduction was found to be significant (p value=0.001). Also endoanal ultrasound showed that tear size significantly reduced among the studied cases. Also the relation of preoperative and postoperative anorectal manometry changes showed a significant increase (p value=0.001). Conclusion: from this study that significant drop of Wexner, combined with ultrasound and anorectal manometry variation between pre and post should be the core of follow up for patients with anal sphincter injury underwent overlap repair