Anterior sphincteroplasty for fecal incontinence: Is the outcome compromised in patients with associated pelvic floor injury?

Introduction: It has been shown that vaginal delivery may result not only in sphincter defects, but also in pelvic floor injury. However, the influence of this type of injury on the etiology of fecal incontinence and its treatment is unknown. The present study was aimed to assess the prevalence of pelvic floor injury in patients who underwent anterior sphincteroplasty for the treatment of fecal incontinence and to determine the impact of this type of injury on the outcome of this procedure. Methods: Women who underwent anterior sphincteroplasty in the past were invited to participate in the present study. With transperineal ultrasound, which has been developed recently, pelvic floor integrity was examined in 70 of 117 patients (60%). Follow-up was obtained from a standardized questionnaire. Results: The median time period between anterior sphincteroplasty and the current assessment was 106 (range, 15-211) months. Pelvic floor injury was diagnosed in 43 patients (61%). Despite the prior sphincteroplasty, an external anal sphincter defect was found in 20 patients (29%). Outcome did not differ, neither between patients with and those without pelvic floor injury, nor between patients with and those without an adequate repair. However, patients with an adequate repair and an intact pelvic floor did have a better outcome than patients with one or both abnormalities. Conclusion: The majority of female patients with incontinence who were eligible for anterior sphincteroplasty have concomitant pelvic floor injury. Based on the present study, it seems unlikely that this type of injury itself has an impact on the outcome of anterior sphincteroplasty.

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