Vaginal Doğum Sonrası Gelişen Fekal inkontinans Olgularında Geç Dönem Sfinkteroplasti Operasyonunun Etkinliğinin Değerlendirilmesi

Abstract

Amaç: Vaginal doğum sonrası fekal inkontinans gelişen olgularda geç dönemde yapılan overlapping sfinkteroplasti ameliyatının etkinliğini değerlendirmektir. Materyal ve Metod: 2010-2014 yılları arasında Harran Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniğinde fekal inkontinans tanısıyla ameliyat edilen 11 olgu retrospektif olarak analiz edildi. Hastaların dosya kayıtlarından; demografik özelliklerinin yanı sıra, uygulanan cerrahi girişim, postoperatif komplikasyonlar ve operasyonun başarı oranları not edildi. Bulgular: Hastaların yaş ortalaması 39 yıl, ortalama doğum sayısı 7 idi. Yedi hastaya doğum sırasında epizyotomi yapılırken, dört hastada ise epizyotomi işleminin yapılmadığı tespit edildi. Altı hastanın gaz-sıvı, 5 hastanın ise gaz-sıvı-katı gaita inkontinansı şikayeti ile başvuru yaptığı saptandı. Tüm hastalara fekal inkontinansı gidermek amacıyla overlapping sfinkteroplasti işlemi uygulandı. Postoperatif komplikasyon olarak hastaların 2'sinde yara enfeksiyonu, 2'sinde ise ameliyat sonrası şiddetli ağrı gelişti. Tüm hastalarda ameliyat sonrası erken dönemde katı ve sıvı gaita inkontinansı kayboldu. Gaz inkontinansında bütün hastalarda belirgin düzelme gözlendi. Jorge-Wexner inkontinans skoruna (JWİS) göre; hastaların ameliyat öncesi inkontinas skoru ortalama 10.45 (8 -15), ameliyat sonrası ortalama 1.ayda 3.64 ( 3-5 ), 6.ayda 4.12 (4- 5), 12.ayda 4.25 (4-5) idi. Hastaların % 72. 5'i ameliyat sonrası sonucu mükemmel/iyi olarak tanımladı. Sonuç: Doğum sonrası fekal inkontinans gelişen olgularda geç dönemde yapılan overlapping sfinkteroplasti fekal inkontinans semptomlarının azalmasında ve hayat kalitesinin artmasında önemli katkı sağlayan basit, etkin cerrahi bir yöntem olarak kabul edilebilir. 

Keywords

• Fekal inkontinans,Vaginal doğum,Overlapping sfinkteroplasti

Evaluation of Effectiveness of the Late Term Sphincteroplasty Operation in Faecal Incontinence Cases that Growing After Vaginal Parturition

Abstract

Background:To evaluate the efficacy of the patients with faecal incontinence after vaginal parturition which made overlapping sphincteroplasty surgery in the late period. Material and Method:We analyzed the eleven patients retrospectively that operated between 2010 and 2014 with the diagnosis of faecal incontinence in Harran University School of Medicine, General Surgery Clinic. From the records of patients; in addition to demographic characteristics; surgical intervention, postoperative complications and success rate of the operation were noted.

Results: The mean age of the patients was 39 years, the average number of birth was 7. Episiotomy was executed to seven patients during parturition, whereas was not executed four patients. It was detected that six patients was admitted from gas and liquid, five patients was admitted from gas,liquid and solid incontinence. All patients was performed overlapping sphincteroplasty procedure to eliminate faecal incontinence. It was developed as postoperatively complication was wound infection in two patients, and developed severe pain in two patients. Solid and liquid faecal incontinence disappeared in the early postoperative period in all patients. Gas incontinence significantly improved in all patients. According to Jorge-Wexner incontinence score; patients' average incontinence score before the operation was 10.45 (8-15); after the operation in first month was 3.64 (3-5), 6th month was 4.12(4-5), 12th month was 4.25(4-5). 72.5% of patients described excellent / good as a result of surgery. Conclusion: Late term applied overlapping sphincteroplasty may be considered effective,simple surgical procedure to reduce fecal incontinence symptoms and contributing to the improvement of quality of life from developing fecal incontinence after parturition

Keywords

• Fecal incontinence,vaginal parturition,overlapping sphincteroplasty

References

1. 1) Rezvan A, Jakus-Waldman S, Abbas MA, Yazdany T, Nguyen J. Review of the Diagnosis, Management and Treatment of Fecal Incontinence. Female pelvic medicine & reconstructive surgery. 2014;2. 2) Akın Önder ZA, Murat Kapan, Fatih Taşkesen, Abdullah Böyük, Celalettin Keleş. Outcomes of surgical treatment in women with anal incontinence secondary to trauma of delivery. Dicle Medical Journal. 2011;38(4):432-5. 3) Roslani AC, Ramakrishnan R, Azmi S, Arapoc DJ, Goh A. Prevalence of faecal incontinence and its related factors among patients in a Malaysian academic setting. Bmc Gastroenterol. 2014;18;14. 4) Wheeler TL, 2nd, Richter HE. Delivery method, anal sphincter tears and fecal incontinence: new information on a persistent problem. Curr Opin Obstet Gynecol. 2007;19(5):474-9. 5) Nevler A. The epidemiology of anal incontinence and symptom severity scoring. Gastroenterology report. 2014;2(2):79-84. 6) Lowder JL, Burrows LJ, Krohn MA, Weber AM. Risk factors for primary and subsequent anal sphincter lacerations: a comparison of cohorts by parity and prior mode of delivery. American journal of obstetrics and gynecology. 2007;196(4):344 e1-5. 7) Öztürk E, Kutlar İ, Balat Ö, Uğur MG, Cebesoy FB, Dikensoy E. Analysis of seconder anal sphincter repair in patient with faecal incontinence. J Turk Soc Obstet Gynecol. 2012;9(1):55-8. 8) Fenner D. Anal incontinence: relationship to pregnancy, vaginal delivery, and cesarean section. Semin Perinatol. 2006 ;30(5):261-6. 9) Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. The New England journal of medicine. 1993;329(26):1905-11. 10) Dorcaratto D, Martinez-Vilalta M, Pares D. [Current indications, surgical technique and results of anterior sphincter repair as a treatment of faecal incontinence]. Cirugia espanola. 2010;87(5):273-81. 11) Garcia V, Rogers RG, Kim SS, Hall RJ, KammererDoak DN. Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques. American journal of obstetrics and gynecology. 2005;192(5):1697-701. 12) Tjandra JJ, Han WR, Goh J, Carey M, Dwyer P. Direct repair vs. overlapping sphincter repair: a randomized, controlled trial. Diseases of the colon and rectum. 2003;46(7):937-42. 13) Lamplin G, Bouvier P, Damon H, Chabert P, Moret S, Chene G,Mellier G. Long-term outcome after overlapping anterior anal sphincter repair for fecal incontinence.Int J Colorectal Dis 2014; 384(14):2005-9. 14) Goetz LH, Lowry AC. Overlapping sphincteroplasty: Is It The standart of Care?Clinic in Colon and Rectal Surgery 2005; 1(18): 22-31.