Management and outcomes of anal sphincter injuries: A retrospective cohort study

Year 2022, , 254 - 257, 01.03.2022

Esra Dişçi , Rıfat Peksöz , Metin Yıldız , İlhan Yıldırgan , Mesud Fakirullahoğlu , Yavuz Albayrak , Enes Ağırman , Sabri Selcuk Atamanalp

https://doi.org/10.28982/josam.1076775

Abstract

Background/Aim: Anal sphincter injury (ASI) is a clinical condition that causes anal incontinence and can severely impair an individual’s quality of life. Overlapping sphincteroplasty (OSP) is the most preferred surgical method for repairing ASI. The present study aimed to discuss the demographic and clinical characteristics of patients who underwent ASI surgical repair in light of the current literature.
Methods: Patients in two groups; males and females, who underwent an operation for grade 3-4 ASI in the General Surgery Clinic at Ataturk University between 2010 and 2021 were retrospectively analyzed. The severity of anal incontinence and quality of life post-operatively using the Wexner score were evaluated. For evaluating post-operative complications, the Clavien–Dindo Classification was used.
Results: Over 12 years, 34 adult patients with a mean age of 35.8 (22–66) years underwent ASI surgery, namely 23 (67.6%) women and 11 (32.4) men. Considering the patients’ etiopathogenesis, obstetric injuries (55.9%) were the most common cause of ASI. All patients underwent overlapping sphincteroplasty (OSP), while 20.6% also underwent protective stoma. According to the Centers for Disease Control and Prevention (CDC), four patients were classified as Grade 1, four as Grade 2, seven as Grade 3 and one as Grade 5.
At a mean follow-up of 35.8 months, the mean Wexner score was 3.59 and the success rate was 88.2% (P=0.445). Males had a longer average hospital stay (P=0.021) and a higher Wexner score (P=0.445), whereas females had a greater complication rate (P=0.388). The quality of life was high, but the Wexner scores were low in all patients.
Conclusion: ASI most commonly occurs in women during childbirth. OSP has a high success rate, and opening a diverting ostomy when needed further increases this rate. The Wexner score is a simple and useful system for assessing anal incontinence.

Keywords

Anal sphincter injury, Anal incontinence, Overlapping sphincteroplasty, Wexner score system

References

• 1. Barbosa M, Glavind-Kristensen M, Moller Soerensen M, Christensen P. Secondary sphincter repair for anal incontinence following obstetric sphincter injury: functional outcome and quality of life at 18 years of follow-up. Colorectal Dis. 2020 Jan;22(1):71-9.
• 2. Chase S, Mittal R, Jesudason MR, Nayak S, Perakath B. Anal sphincter repair for fecal incontinence: experience from a tertiary care centre. Indian J Gastroenterol. 2010 Jul;29(4):162-5.
• 3. Kołodzıejczak, Małgorzata, Sudoł-Szopınska IWONA. Anal sphincter injuries in -daily surgical practice-diagnosis and treatment. Pelviperineology. 2014 Mar;33(1):17-21.
• 4. Barisić G, Krivokapić Z, Marković V, Popović M, Saranović D, Marsavelska A. The role of overlapping sphincteroplasty in traumatic fecal incontinence. Acta Chir Iugosl. 2000;47(4 Suppl 1):37-41.
• 5. Demirbas S, Atay V, Sucullu I, Filiz AI. Overlapping repair in patients with anal sphincter injury. Med Princ Pract. 2008;17(1):56-60.
• 6. Pinta T, Kylänpää-Bäck ML, Salmi T, Järvinen HJ, Luukkonen P. Delayed sphincter repair for obstetric ruptures: analysis of failure. Colorectal Dis. 2003 Jan;5(1):73-8.
• 7. Kuismanen K, Nieminen K, Karjalainen K, Lehto K, Uotila J. Outcomes of primary anal sphincter repair after obstetric injury and evaluation of a novel three-choice assessment. Tech Coloproctol. 2018 Mar;22(3):209-14.
• 8. Thiagamoorthy G, Johnson A, Thakar R, Sultan AH. National survey of perineal trauma and its subsequent management in the United Kingdom. Int Urogynecol J. 2014 Dec;25(12):1621-7.
• 9. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993 Jan;36(1):77-97.
• 10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13.
• 11. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009 Aug;250(2):187-96.
• 12. Mik M, Rośniak K, Narbutt P, Dziki Ł, Tchórzewski M, Trzciński R, et al. Anterior overlapping sphincteroplasty--who benefits from the surgery? Pol Przegl Chir. 2014 Jan;86(1):33-8.
• 13. Nelson RL. Epidemiology of fecal incontinence. Gastroenterology. 2004 Jan;126(1 S uppl 1):S3-7.
• 14. Barisic GI, Krivokapic ZV, Markovic VA, Popovic MA. Outcome of overlapping anal sphincter repair after 3 months and after a mean of 80 months. Int J Colorectal Dis. 2006 Jan;21(1):52-6.
• 15. Orhon R, Eren SH, Karadayı S, Korkmaz I, Coşkun A, Eren M, et al. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. Ulus Travma Acil Cerrahi Derg. 2014 Jul;20(4):258-64.
• 16. Tjandra JJ, Han WR, Goh J, Carey M, Dwyer P: Direct repair vs. overlapping sphincter repair. Dis Colon Rectum 2003;46:937–43.
• 17. Elton C, Stoodley BJ. Anterior anal sphincter repair: results in a district general hospital. Ann R Coll Surg Engl. 2002 Sep;84(5):321-4.
• 18. Devesa JM, Vicente R, Abraira V. Visual analogue scales for grading faecal incontinence and quality of life: their relationship with the Jorge-Wexner score and Rockwood scale. Tech Coloproctol. 2013 Feb;17(1):67-71.
• 19. Rothbarth J, Bemelman WA, Meijerink WJ, Stiggelbout AM, Zwinderman AH, Buyze-Westerweel ME, et al. What is the impact of fecal incontinence on quality of life? Dis Colon Rectum. 2001 Jan;44(1):67-71.
• 20. Parnell BA, Whitehead WE, Geller EJ, Jannelli ML, Connolly A. Overlapping anal sphincteroplasty: impact of suture selection on bowel symptoms. J Reprod Med. 2011 May-Jun;56(5-6):187-91.
• 21. Kettle C, Johanson RB. Absorbable synthetic versus catgut suture material for perineal repair. Cochrane Database Syst Rev. 2000;(2):CD000006.
• 22. Nikiteas N, Korsgen S, Kumar D, Keighley MR. Audit of sphincter repair. Factors associated with poor outcome. Dis Colon Rectum. 1996 Oct;39(10):1164-70.
• 23. Goetz LH, Lowry AC. Overlapping sphincteroplasty: is it the standard of care? Clin Colon Rectal Surg. 2005 Feb;18(1):22-31.
• 24. Maldonado PA, Mcintire D, Corton MM. Long-Term Outcomes After Overlapping Sphincteroplasty for Cloacal-Like Deformities. Female Pelvic Med Reconstr Surg. 2019 Jul/Aug;25(4):271-8.