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Role of perineal anterior overlapping sphincteroplasty in management of fecal incontinence

J M V Amarjothi .

Abstract


Aim : To evaluate the outcomes of perineal anterior  overlapping sphincteroplasty in patients with fecal incontinence following injury to anal sphincter. Materials and Methods : This is an analysis of 44  patients who  presented to our department between  2010 and 2017.Analysis included the time of presentation, work up (Saline holding test,Transperineal ultrasound and MRI perineum )type of injury ,cause of injury, surgery done and follow up  with maximum follow up of  7 years(range-8 months-7 years). Results : The most common  surgical cause for fecal incontinence was obstetric injury (n=40,90.9%).The patients with obstetric injuries were aged 30.25(mean), median-33.5 yrs and range(21-48). These patients were associated with  rectovaginal fistula(n=18,45%). 62%                  (n=25 )  had undergone episiotomy during childbirth  and 7.5%(n=3) had prior forceps instrumentation. All of them (n=40) underwent overlapping anterior sphincteroplasty with 2-0 or 3-0 vicryl Post operatively, in patients with obstetric injuries, 10% had wound infections which resolved on antibiotics. The preoperative Wexner score showed a  improvement from 12.5(11-15) to  post operative score of 9.725(9-12)  at  8 months where 0  and 20 correspond to perfect  continence and incontinence respectively.The  post operative  continence score in non obstetric patients(10.67(range-10-13)  was also  similar On  follow up, Patients with overlapping sphincteroplasty for obstetric injuries also had excellent continence (70%, n=28). Conclusion:

If conservative treatment fails, anterior sphincteroplasty can be  advocated in fecal incontinence  to improve functioning and quality of life of incontinent patients. irrespective of time of presentation ,traumatic  anal sphincter injuries can be effectively managed by overlapping sphincteroplasty with good short and long term continence  with minimal morbidity


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