Long-term success of anal sphincter repair varies with age
MedWire News: Anterior anal sphincter repair for severe fecal incontinence provides a sustained, long-term improvement in continence among younger women, research shows.
In older patients, however, the surgery is less likely to result in a good outcome.
"Older patients with significant incontinence need to be counseled about the limited long-term improvements that they might expect with sphincter repair," say Oliver Jones (John Radcliffe Hospital, Oxford, UK) and colleagues.
Anterior sphincter repair is a recommended treatment for women with sphincter defects and fecal incontinence. New therapies have emerged in recent years, including sacral nerve stimulation, and these alternative treatment options are now available for patients with fecal incontinence.
With the emergence of these new treatments, the researchers performed a retrospective review to assess the long-term outcomes of sphincter repair in order to determine its place in the treatment armamentarium.
As reported in Colorectal Disease, the group identified 113 female patients who underwent anterior sphincter repair at their hospital between 1994 and 2006. Of these, 58% responded to a questionnaire designed to assess the patient's views on functional outcomes following surgery.
Overall, 73% of women believed the surgery resulted in an initial improvement in continence. After a median follow up of 8.8 years, however, just 56% of women said their incontinence remained better than it was before the surgery.
Of the women who stated their incontinence remained improved since the anal sphincter repair, 49% said that some deterioration had occurred since the initial surgery. Nearly all the women felt that the deterioration was gradual.
Just over half of the women who responded to the questionnaire said they believed the operation was successful based on the long-term results, and 71% were happy having had the initial surgery.
Incontinence and quality-of-life scores tended to track with patient's subjective responses. Perfect continence, as measured by various scoring systems, was rare, according to Jones and colleagues.
Importantly, age at the time of surgery was a powerful predictor of subjective outcomes.
Women who reported improved long-term outcomes had a median age of 38 years at the time of surgery compared with 56 years for those women who did not report long-term improvements, a difference that was statistically significant.
For women who were at least 50 years old at the time of surgery, just 27% reported sustained improvement in the long-term, whereas 75% of women younger than 50 years reported improvements in the long term.
Healthier tissue and better healing likely explain the better outcomes in younger patients, Jones and colleagues suggest.
By MedWire Reporters