Surgical repair of fecal incontinence. Correlation of sonographic anal sphincter integrity with subjective cure.

Objective: To assess the subjective cure rates in a group of women who had undergone delayed/secondary anal sphincteroplasty and in a subgroup of women to compare the integrity of the anal sphincteric complex as evaluated by physical examination and vaginal probe anal sonography with subjective cure rates of fecal incontinence.

Study Design: The charts of all patients who underwent delayed anal sphincteroplasty from 1991 to 1995 were reviewed for demographics and perioperative information. Available patients underwent interview, physical examination and vaginal probe anal sonography. Paired t-test, Wilcoxon rank sum and Fisher's exact test were used to evaluate the data.

Results: The mean age of the 16 patients prior to sphincteroplasty was 35 years (SD +/- 12) and mean parity 2 (SD +/- 1.8). In 94%, fecal incontinence was attributed to obstetric trauma and in one was secondary to rape. Anal sphincteroplasty was accomplished using the overlapping technique in seven (44%) and utilizing the end-to-end technique in the remainder; all patients also underwent posterior colpoperineorrhaphy. Information on postoperative symptomatology was available from 10 patients (63%). Subjectively 4 were cured (40%), 4 were improved (40%), and 2 were unimproved (20%). Of these 10 women, seven agreed to undergo postoperative physical examinations; 5 (71%) had intact external sphincters, and 2 (29%) did not. On vaginal probe anal sonography, the external and internal sphincters were intact in six (86%) and five (71%), respectively. There was no correlation between patients' symptoms and the integrity of the sphincter as noted on physical or sonographic evaluation (P > .05). Physical examination accurately identified sphincteric anatomy in six of seven (86%) when compared to sonographic examination.

Conclusion: Subjective success (cured or improved) of anal sphincteroplasty in this series was 80%). We found no correlation between symptomatic relief and anal sphincter integrity as evaluated by physical and sonographic examination.