Saket Kumar, Mch, Prabhu Singh, MS, Rahul R, Mch, Pradeep Joshi, Mch. king george medical university
Background: Effective management of anal sphincter injury with fecal incontinence remains challenging. Overlapping sphincteroplasty is considered the standard surgical procedure for such conditions, however its long-term results are not satisfactory. Incomplete sphincter repair and neurovascular damage during sphincteroplasty have been held responsible for disappointing outcomes in the long-term. The aim of this study was to evaluate endoanal ultrasound guided overlapping sphincteroplasty technique to ensure completeness of sphincter repair (mapping of anal sphincter complex) and preservation of neurovascular pedicle intra-operatively.
Patients and method: The study was conducted at a tertiary health care center in India. Between January 2014 and june 2015, eight patients with damaged anal sphincters (90- 120 degrees) who underwent endoanal ultrasound guided overlapping sphincteroplasty, were evaluated in the study. Post-operative outcomes, anal manometry findings and fecal incontinence scores (St. Mark’s Incontinence Score, SMIS ) were recorded prospectively.
Results: Eight patients (7 female) with a median age of 27 years (range 21-50) were included in the study. Six patients had obstetric associated anal sphincter injury; while other two had post fistulectomy anal sphincter damage. Preoperative assessment of all the patients revealed anterior sphincter defect none more than 120°. The median fecal incontinence score was 15.5 (range 12-18). All repairs were done under endoanal ultrasound guidance. Postoperative evaluation revealed marked improvement in anal resting and squeeze pressures (median squeeze pressure 70mm Hg) as well as fecal incontinence scores ( median-7.5 range 7–9 ). These values were recorded at 18 month follow-up. Median follow-up was 28 months (range 18-36 months).
Conclusion: Use of intra-operative ultrasound ensures the completeness of repair and may decrease chances of neurovascular injury. This may translate in improved long-term functional outcomes after overlapping sphincteroplasty.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84421
Program Number: ETP738
Presentation Session: Emerging Technology Poster
Presentation Type: Poster