Long-term results of postanal repair for neurogenic faecal incontinence
- 1 January 1994
- journal article
- research article
- Published by Oxford University Press (OUP) in British Journal of Surgery
- Vol. 81 (1) , 140-144
- https://doi.org/10.1002/bjs.1800810151
Abstract
Between 1984 and 1986, 54 patients underwent postanal repair for neurogenic faecal incontinence. Forty‐two (41 women) were available for follow‐up 5–8 (median 6·2) years after operation. Of these, 34 women attended for clinical and anorectal physiological assessment. Anal endosonography was also performed in 30 patients. In the 34 patients examined, continence categories (Browning and Parks' classification) of C (n = 12) and D (n = 22) before surgery became A (n = 2), B (n = 12), C (n = 16) and D (n = 1) at 6 months and A (n = 4), B (n = 5), C (n = 21) and D (n = 4) at 5–8 years. Nine patients therefore had continence for solids and liquids, five of whom were incontinent to flatus, in the long term. Assessment of outcome by patients revealed long‐term improvement in 28 and no change in six. Two of the 34 patients assessed were housebound because of incontinence. Of the total of 54 patients, only one required a stoma. The length of the anal canal increased significantly from a preoperative median (range) of 2·0 (1·5–4·0) cm to 3·8 (1·8–5·5) cm 5–8 years after surgery. Perineal descent at rest decreased markedly. Progression of neuromuscular damage was demonstrated by prolongation of the pudendal nerve terminal motor latency from a median (range) 2·38 (1·80–3·35) ms to 2·80 (2·20–4·25) ms and increasing median (range) fibre density in the external sphincter, from 1·86 (1·76–2·40) to 3·63 (2·03–6·20). The pudendal nerve terminal latency was the only preoperative physiological variable that correlated significantly with long‐term outcome (A and B 2·20 ms versus C and D 2·65 ms, P < 0·05). At long‐term assessment, maximal anal squeeze pressure was the only physiological variable that correlated significantly with clinical outcome. Anal endosonography revealed a clinically undetected sphincter defect in 19 of 30 patients examined but the presence of a defect did not relate to clinical outcome.Keywords
Funding Information
- Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
- St Mark's Research Foundation
This publication has 22 references indexed in Scilit:
- Increase in pudendal nerve terminal motor latency with defaecation strainingBritish Journal of Surgery, 1988
- Prospective study of conservative and operative treatment for faecal incontinenceBritish Journal of Surgery, 1988
- Prospective study of the effects of postanal repair in neurogenic faecal incontinenceBritish Journal of Surgery, 1988
- Risk factors in childbirth causing damage to the pelvic floor innervationInternational Journal of Colorectal Disease, 1986
- Evidence of pudendal neuropathy in patients with perineal descent and chronic straining at stool.Gut, 1984
- Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinenceBritish Journal of Surgery, 1984
- Postanal repair for neuropathic faecal incontinence: Correlation of clinical result and anal canal pressuresBritish Journal of Surgery, 1983
- Increased motor unit fibre density in the external anal sphincter muscle in ano-rectal incontinence: a single fibre EMG study.Journal of Neurology, Neurosurgery & Psychiatry, 1980
- Sphincter denervation in anorectal incontinence and rectal prolapse.Gut, 1977
- Anorectal IncontinenceProceedings of the Royal Society of Medicine, 1975