[Pre- and retro-anal myorrhaphy in the treatment of severe anal incontinence. Clinical and manometric results].

Optimal surgical treatment for neuropathic severe anal incontinence is still controversial: the combination of pre-anal levator plication and post-anal repair (Parks) has been recently described. This non-randomized prospective study evaluated the results of pre- and post-anal repair for medically non-corrected neuropathic and traumatic anal incontinence. Ten female patients (mean age: 59) were operated by pre- and post-anal levatorplasty (total pelvic floor repair). Incontinence was scored clinically according to the Jorge and Wexner score (normal: 0, max.: 20) and with no rectal manometry, before and after surgery. Fourteen months after surgery (range: 9-18 months), anal continence for stools was achieved in 7 out of 10 patients: the patients clinical scores decreased from 15 (12-19) pre-operatively to 6 (1-18) post-operatively (p < 0.01) (4 for good results, 17 for the 3 failures). No manometric parameter was able to predict or explain postoperative functional results. Only anal canal length and maximal amplitude of anal contractions were significantly improved from 3.0 cm (2.0-4.0) to 3.5 cm (2.2-4.5), p < 0.05) for the former and from 54 to 69 cm H2O for the latter (p < 0.05). In this small series, pre- and post-anal levatorplasty effectively corrected severe neuropathic anal incontinence in the short-term, in 70% of cases. In our experience, this technique appears to be superior to post-anal repair, without increasing technical problems or morbidity.