Outcomes Review of Overlap External Anal Sphincteroplasty in a Single Institution Urogynecology Practice
Drs. A Walter, A. Steele

David Grant Medical Center

Vacaville, California

Objective:  The primary surgical option for correction of post-obstetric fecal incontinence due to disruption of the anal sphincter musculature is overlapping external anal sphincteroplasty (OEAS).  The vast majority of reports on the efficacy and morbidity of OEAS have been published by colorectal surgeons when performed as a stand-alone procedure.  Given the focus of gynecologic surgeons to offer global repair of pelvic floor defects, OEAS in our practice is often being performed with concomitant repairs for gynecologic disease, pelvic organ prolapse and/or urinary incontinence.  To our knowledge, the efficacy and morbidity of OEAS in this setting in the hands of gynecologic surgeons has not been previously reported.

Materials and Methods:   We performed a retrospective review of all patients who underwent OEAS with or without concurrent urogynecologic procedures performed by 2 fellowship trained urogynecologists between November 1999 and June 2001.  Patient demographics, pre- and post-operative fecal continence (Parks Score: 1=complete continence; 4=complete incontinence), types of diagnostic evaluation, concurrent operative procedures, and complications were ascertained via chart review.  Additional data on post-operative fecal continence was obtained by a mailed 5-item Wexner Continence Questionnaire (0 = complete continence; 20 = complete incontinence) and a 3-item surgical satisfaction questionnaire (0 = complete dissatisfaction; 10 = complete satisfaction).

Results:   13 patients underwent OEAS with a mean follow-up of 2.3 months (range 1.0-7.5).  Mean age was 53 (range 20-78) and parity 2.5 (median 2; range 1-5).  Pre-operative evaluations including digital rectal exam in all patients, a confirmatory endoanal ultrasound in 85% and pudendal nerve terminal latency evaluations in 15%.  The mean pre-operative Parks Score was 3.8 (median 4; range 3-4).  85% of patients underwent at least one concurrent urologic or gynecologic procedure.  Complications were limited to one rectotomy that was primarily repaired and 5 perineal incision breakdowns, which healed secondarily without sequale.  Mean post-operative Parks Score was improved to 1.7 (median 2, range 1-3).  62% of patients responded to the questionnaire with a mean follow-up of 8.4 months (range 4-16) since surgery.  The mean Wexner Continence Score was 5.5 (range 3-9) and the mean overall satisfaction with the surgical outcome was 8.1 (range 3-10).  These results are similar to those reported in the colorectal surgery literature.

Conclusions :  OEAS performed with concurrent urogynecologic procedures demonstrates acceptable morbidity, efficacy and patient satisfaction.
Key Words:   overlapping anal sphincteroplasty, gynecologic surgery, outcomes