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

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

Kaynakça

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