Outcome and Preoperative Predictive Factor after Complete Anatomical Repair in Perineal Obstetric Injury

ABSTRACT

PURPOSE: To assess the outcome of complete anatomical repair (sphincteroplasty, rectal wall plication, rectovaginal septum plication, perineal body repair, levatoroplasty) and to identify the preoperative factors influencing the outcome for the perineal obstetric injury. METHODS: Eighteen, consecutive female patients who had undergone complete anatomical repair with chronic fecal incontinence due to perineal injury during 13 months were evaluated. Mean age was 48.9+/-10.1 years, mean duration of symptom was 18.9 (range 1-33) years, mean delivery numbers were 2.8 +/-1.2 times, and mean follow up was 11.9 +/- 4.7 months. The predictive factors were age, manometry, PNTML (pudendal nerve terminal motor latency), rectal sensation, RAIR (rectoanal inhibitory reflex), duration of symptom, angle of sphincter defect, vaginal delivery numbers, hospital stay, follow-up period, wound healing period, and Wexner's incontinence score. RESULTS: The anatomical success rate via endoanal ultrasonography was 100%, complication rate was 5.5%, and functional success rate (Wexners' score < or =5) was 88.9%. The patients showed lower maximal resting pressure, maximal squeezing pressure, maximal voluntary contraction, mean resting pressure, mean squeezing pressure, and maximal tolerable volume than the normal control group (p<0.05). The median incontinence score was significantly decreased after surgery (pre op=12.2 vs post op=2.9) (p<0.05). Among the preoperative predictive factors, the incontinence score correlated significantly with postoperative functional success (r=0.552, P=0.017). CONCLUSIONS: Complete anatomical repair showed an excellent anatomical result and a good functional outcome. Patient with high preoperative incontinence score had a tendency for postoperative residual incontinence.