Audit of postanal repair in the treatment of fecal incontinence

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Abstract
The short-term results of postanal repair for idiopathic fecal incontinence are satisfactory but data on long-term outcome are lacking. This study was carried out to document the short-term and long-term results of this operation and to determine whether preoperative tests predict long-term outcome. Thirty-six patients (33 females; mean age, 57 years) with major idiopathic fecal incontinence operated on by one surgeon were studied. Patients had resting and voluntary contraction anal pressures and pudendal nerve terminal motor latencies (PNTML) measured preoperatively. Symptoms were evaluated at 6 months after operation and again at a median of 25 (range, 6-72) months in all 36 patients. Symptoms were classified as: Group C, no improvement or worse; Group B, minor improvement; and Group A, marked improvement in comparison to the patient's preoperative symptoms. Seventeen patients had postoperative physiology performed. At 6 months there were 6 (17 percent) patients in Group C, 12 (33 percent) in Group B, and 18 (50 percent) in Group A. At final follow-up there were 17 (47 percent) in Group C, 9 (25 percent) in Group B, and 10 (28 percent) in Group A. Comparison of the preoperative data in the final outcome groups showed (mean±SE): Groups A and Bvs.Group C-resting pressure, 24.6±6 cm H2Ovs.40.5±12.2 (P=0.2), voluntary contraction pressure, 23.7±5.7vs.11.8±3.6 (P=0.09), and PNTML, 3.2±0.75 mSvs.3.3±0.99 (P=0.8). Mean differences between postoperative and preoperative results were: resting pressure, 28±8.2 cm H2O (P=0.003); voluntary contraction pressure, 19.5±6.7 (P=0.01); and PNTML, −0.3±0.29 mS (P=0.3). At 6 months 83 percent of patients had obtained some benefit from postanal repair but only 53 percent maintained this improvement with only 28 percent being markedly better. There was a trend toward a more favorable outcome in patients with greater squeezing pressures preoperatively but other tests were not of long-term predictive value.