ABSTRACT
Purpose: this prospective study was undertaken to evaluate the efficacy of overlapping external sphincter repair [OASR] with internal anal sphincter [IAS] imbrication in the treatment of traumatic fecal incontinence and its impact on anal canal physiology
Methods: Between June 1999 and May 2001, a total number of 12 patients with traumatic anal incontinence were treated in the Colorectal Surgery Unit in Mansoura University Hospital. They were 10 females and 2 males with a mean age 32.7 years. The cause of incontinence was obstetric trauma in 8 patients, surgical trauma in 3 patients and penetrating anal trauma in one patient. All Patients underwent complete anorectal laboratory investigations in the form of manometric studies, endoanal ultrasound and pudendal nerve terminal motor latency. OASR with IAS imbrication was carried out for all patients and they were followed up thereafter for a period of 6 - 10 months [mean 7.75 +/- 1.29 M]
Results: 11 / 12 patients were clinically improved with complete continence observed in five patients [41.60%]. This was associated with significant improvement in the manometric parameters, maximum resting pressure [MRP], maximum squeeze pressure [MSP], functional anal canal length [ACL]. and recto anal inhibitory reflex [RAIR]. Postoperative morbidity was only related to wound infection in one patient [8.4%] and fecal impaction in another one [8.40%]
Conclusion: Overlapping external anal sphincter repair with internal anal sphincter imbrication is a good technique that continues to give good results in the majority of patients, with an anatomic sphincter defect through the augmentation of MRP, MSP, ACL as well as the recto anal inhibitory reflex