Additional secure circular suture during sphincteroplasty — preliminary results on the efficacy of fecal incontinence surgery in urogynecological patients
, 1, 1, 2, 1
Abstract
Objectives: The paper is a ten case series study presenting women with complex pelvic floor disorders involving fecal incontinence (FI) with stress urinary incontinence or pelvic organ prolapse.
Our study aimed at ascertaining whether FI-induced sphincteroplasty with an additional secure circular suture around the external anal sphincter muscle (EAS) may improve long term success rates.
Materials and methods: Twelve patients had scheduled urogynecological surgery and overlapping sphincteroplasty with the placement of an additional circular suture around the EAS. Of these, the status of ten women was established by way of the Cleveland Clinic Fecal Incontinence Score/Wexner Score before and about 70 months after surgery.
Results: Statistical analysis of fecal incontinence score showed that patients were not completely cured from FI, but were significantly better (p = 0.011).
Conclusions: A circular secure suture around the external anal sphincter in FI patients may help to improve anal sphincter function.
Keywords: fecal incontinencepelvic organ prolapseurinary incontinencesphincteroplasty
References
- Wald A. Clinical practice. Fecal incontinence in adults. N Engl J Med. 2007; 356(16): 1648–1655.
- McManus BP, Allison S, Hernánchez-Sánchez J. Anterior sphincteroplasty for fecal incontinence: predicting incontinence relapse. Int J Colorectal Dis. 2015; 30(4): 513–520.
- Faltin DL, Sangalli MR, Curtin F, et al. Prevalence of anal incontinence and other anorectal symptoms in women. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12(2): 117–120; discussion 121.
- Jorge M, Wexner S. Etiology and management of fecal incontinence. Diseases of the Colon & Rectum. 1993; 36(1): 77–97.
- Karram MM. Chirurgiczne leczenie nietrzymania stolca. In.: Baggish MS, (eds). Atlas chirurgii ginekologicznej i anatomii miednicy. Wyd polskie. ; 2009: 971–980.
- Garlandand B, Hull T. Overlapping repair. In: Wexner SD, Fleshman JD (eds). Master Techniques in Surgery. Colon and Rectal Surgery: Anorectal Operations. Wolters Kluwer, Philadelphia. : 2012.
- Jackson SL, Weber AM, Hull TL, et al. Fecal incontinence in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 1997; 89(3): 423–427.
- Jelovsek JE, Barber MD, Paraiso MF, et al. Functional bowel and anorectal disorders in patients with pelvic organ prolapse and incontinence. Am J Obstet Gynecol. 2005; 193(6): 2105–2111.
- Bezerra LR, Vasconcelos Neto JA, Vasconcelos CT, et al. Prevalence of unreported bowel symptoms in women with pelvic floor dysfunction and the impact on their quality of life. Int Urogynecol J. 2014; 25(7): 927–933.
- Oom DMJ, Gosselink MP, Schouten WR. Anterior sphincteroplasty for fecal incontinence: a single center experience in the era of sacral neuromodulation. Dis Colon Rectum. 2009; 52(10): 1681–1687.
- Bravo Gutierrez A, Madoff RD, Lowry AC, et al. Long-term results of anterior sphincteroplasty. Dis Colon Rectum. 2004; 47(5): 727–31; discussion 731.
- Lehto K, Hyöty M, Collin P, et al. Seven-year follow-up after anterior sphincter reconstruction for faecal incontinence. Int J Colorectal Dis. 2013; 28(5): 653–658.
- Halverson AL, Hull TL. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum. 2002; 45(3): 345–348.
- Maslekar S, Gardiner AB, Duthie GS. Anterior anal sphincter repair for fecal incontinence: Good longterm results are possible. J Am Coll Surg. 2007; 204(1): 40–46.
- Zutshi M, Tracey TH, Bast J, et al. Ten-year outcome after anal sphincter repair for fecal incontinence. Dis Colon Rectum. 2009; 52(6): 1089–1094.
- Karoui S, Leroi AM, Koning E, et al. Results of sphincteroplasty in 86 patients with anal incontinence. Dis Colon Rectum. 2000; 43(6): 813–820.
- Glasgow SC, Lowry AC. Long-term outcomes of anal sphincter repair for fecal incontinence: a systematic review. Dis Colon Rectum. 2012; 55(4): 482–490.
- Barisic GI, Krivokapic ZV, Markovic VA, et al. Outcome of overlapping anal sphincter repair after 3 months and after a mean of 80 months. Int J Colorectal Dis. 2006; 21(1): 52–56.
- Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013(6): CD002116.
- El-Gazzaz G, Zutshi M, Hannaway C, et al. Overlapping sphincter repair: does age matter? Dis Colon Rectum. 2012; 55(3): 256–261.
- Mannella P, Giannini A, Russo E, et al. Personalizing pelvic floor reconstructive surgery in aging women. Maturitas. 2015; 82(1): 109–115.
