Anal sphincter repair: a report of 60 cases and review of the literature.

This is a retrospective review of 58 patients undergoing surgery for anal incontinence at the Cleveland Clinic. Forty-four patients had overlapping sphincter repairs, nine had postanal repairs, three had a combination of overlapping repair and postanal repair and two had Silastic slings. An associated loop colostomy or ileostomy was performed in 19 patients (33%). Satisfactory continence was attained in 86% of patients with direct sphincter injury (overlapping sphincter repairs) and this is comparable with the experience of others. These results with the postanal repair for patients with neurogenic incontinence were poor, however, as four of the nine were complete failures. Poor results were directly related to the age of the patient (P less than 0.0001) and the duration of incontinence (P less than 0.02). It was concluded that direct sphincter injury (obstetric, operative or traumatic) is effectively treated by an overlapping sphincter repair. Incontinence secondary to a degenerative neuropathy affecting the anal sphincter mechanism, however, whether it occurs in conjunction with a pre-existing sphincter injury or alone, is often not cured by surgery, that is, by postanal repair.