Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138, Naples, Italy.
Updates Surg. 2023 Sep;75(6):1423-1430. doi: 10.1007/s13304-023-01609-1. Epub 2023 Jul 29.
Anal incontinence is a frequent pathological condition with devastating impact on quality of life. The prevalence is approximately 15% of the population, with higher incidence reported in the elderly and multiparous women, and several factors have a major role in its pathogenesis, such as anatomical sphincter defects (Glasgow and Lowry in Dis Colon Rectum 55(4): 482-490, 2012), delivery injuries, and colorectal, uro-gynecological, and perineal surgery. The direct surgical approach is the gold standard treatment for fecal incontinence, especially through anterior sphincteroplasty, although a permanent defect of continence persists over time. The aim of our study is to evaluate, throughout a systematic review of the literature, the short- and long-term outcomes of sphincteroplasty performed for obstetric injuries anal incontinence. A systematic review of the studies published in the literature from January 2000 to December 2021 was performed in accordance with the PRISMA guidelines. Of the 2543 studies extrapolated, only eight fulfilled the inclusion criteria and were admitted represented by retrospective and prospective studies. The data analyzed from the included studies were number and mean age of the female population, and incontinence improvement with preoperative and postoperative short- and long-term outcomes, as reported by QoL questionaries and incontinence scores. Overall 355 patients with obstetric sphincter damage underwent sphincteroplasty with an anterior external sphincter overlapping procedure. A consistent improvement in fecal incontinence at short-term follow-up with relative improvement in QoL was reported. In 7 of 8 studies, the authors found a progressive worsening of the incontinence symptoms on the long-term follow-up. However, it is not clear whether the decrease in long-term continence results is parallel to a simultaneous decrease in QoL scores. Nevertheless, compared to the preoperative findings, the improvement was maintained in the long-term follow-up. Despite the limited data in the literature, a properly performed sphincteroplasty can guarantee a consistent improvement of the continence in short term with encouraging outcomes, especially for solid stool continence, in long time. We believe that anterior sphincteroplasty, as a low cost, feasible, and safe procedure, still has a role in the treatment of fecal incontinence for obstetric injury. Further large cohort randomized clinical trials are necessary to validate these results.
肛门失禁是一种常见的病理性疾病，对生活质量有毁灭性的影响。其患病率约为人群的 15%，在老年人和多产妇中发病率更高，且有几个主要因素在其发病机制中起作用，例如解剖学括约肌缺陷（Glasgow 和 Lowry 在 Dis Colon Rectum 55(4): 482-490, 2012）、分娩损伤以及结直肠、泌尿妇科和会阴手术。直接手术方法是治疗粪便失禁的金标准，特别是通过前括约肌成形术，尽管随着时间的推移，对节制的永久性缺陷仍然存在。我们的研究目的是通过对文献进行系统回顾，评估针对产科损伤肛门失禁进行括约肌成形术的短期和长期效果。根据 PRISMA 指南，对 2000 年 1 月至 2021 年 12 月期间发表的文献进行了系统的研究回顾。从推断的 2543 项研究中，只有八项符合纳入标准，并被代表回顾性和前瞻性研究的研究所采用。从纳入的研究中分析的数据是女性人群的数量和平均年龄，以及术前和术后短期和长期结果的失禁改善情况，这些结果通过生活质量问卷和失禁评分报告。总体而言，355 名患有产科括约肌损伤的患者接受了前外侧括约肌重叠术的括约肌成形术。报告称，在短期随访中，粪便失禁有一致的改善，生活质量也相对改善。在 8 项研究中的 7 项中，作者发现随着时间的推移，失禁症状逐渐恶化。然而，尚不清楚长期节制结果的下降是否与 QoL 评分的同时下降平行。尽管文献中的数据有限，但正确进行的括约肌成形术可以保证短期的节制得到持续改善，长期随访结果令人鼓舞，尤其是对于固体粪便节制。我们认为，前括约肌成形术作为一种低成本、可行且安全的手术，在治疗产科损伤引起的粪便失禁方面仍然具有作用。需要进一步进行大型队列随机临床试验来验证这些结果。
