Multimodal Management of Traumatic Faecal Incontinence Focused on Sphincteroplasty: Long-term Outcomes From a Single Center Case Series

Background: The management of patients with fecal incontinence and an external anal sphincter (EAS) defect remains controversial. Methods: : We present a retrospective series of overlapping anal sphincteroplasties performed between 1985-2013 by a single surgeon supplemented by selective puborectalis plication and internal anal sphincter repair. Patients were clinically followed along with anorectal manometry, continence scoring (Cleveland Clinic Incontinence Score - CCS) and patient satisfaction scales. Patients with a suboptimal outcome were managed with combinations of biofeedback therapy, (BFT) peripheral tibial nerve stimulation (PTNS), sacral nerve stimulation (SNS) or repeat sphincteroplasty. Results: : There were 120 anterior sphincter repairs with 90 (75%) levatorplasties and 84 (70%) IAS repairs. Over a median follow-up of 120 months (range 60-173.7 months) there were significant improvements in the recorded CCIS values (90.8% with a preoperative CCIS > 15 vs. 2.5% postoperatively; P < 0.001). There were 42 patients who required ancillary treatment with 4 repeat sphincteroplasties, 35 patients undergoing biofeedback therapy, 10 patients treated with PTNS and 3 managed with SNS implants with an ultimate good functional outcome in 92.9% of cases. No difference was noted in ultimate functional outcome between those treated with sphincteroplasty alone compared with those who needed ancillary treatments (97.1% vs. 85.7%, respectively). Overall, 93.3% considered the outcome as either good or excellent. Conclusions: : Long-term functional outcomes of an overlapping sphincteroplasty are good. If the initial outcome is suboptimal, response to ancillary treatments remains good and patients are not compromised by a first-up uncomplicated sphincter repair.