anal sphincter repair.pdf

Advantages of a Posterior Fourchette Incision in Anal Sphincter Repair Maybelle Tan, M.B., Deirdre M. OHanlon, M.D., F.R.C.S.(Gen), Mary Cassidy, R.G.N., P. Ronan OConnell, M.D., F.R.C.S.I. From the Department of Surgery, Mater Misericordiae Hospital, Dublin, Ireland PURPOSE: Delayed repair of obstetric-related anal sphincter injury remains problematic, and perineal wound break- down is common. The aim of this study was to assess the outcome after overlap anal sphincter repair and to deter- mine the advantages, ff any, of a posterior fourchette inci- sion (n = 18) compared with a conventional perineal inci- sion (n = 32). METHODS: Fift T females of mean parity 2.8 (standard deviation, 1.6) underwent repair in a five-year period. The mean foUow-up was 23 months. Assessment was by anal vector manometry, endoanal ultrasound, and continence scoring. RESULTS: Fmactional outcomes were similar in the two groups. Repair increased squeeze-pres- sure increment and improved continence scores in both groups. Postoperative wound complications were fewer when a posterior fourchette incision was used compared with a perineal incision (11 vs. 44 percent, respectively; P 0.05). CONCLUSIONS: Delayed anal sphincter repair improves continence. A posterior fourchette approach is associated with fewer postoperative wound complications without compromising the quality of repair and the func- tional outcome. [Key words: Anal sphincter; Anterior sphincter repair: obstetric injury; Continence; Wound] Tan M, OHanlon DM, Cassidy M, OConnell PR. Advantages of a posterior fourchette incision in anal sphincter repair. Dis Colon Rectum 2001;44:1624-1629. F ecal incontinence is a common problem affecting 2 percent of all adults and 7 percent of all healthy adults more than the age of 65 years. The most com- mon cause is structural damage during childbirth, which accounts for the eightfold female preponder- ance. :-3 Up to 2 percent of females who deliver vag-