Strengths and Limitations
This is, to our knowledge, the largest study evaluating outcomes after transvaginal anal sphincter repair. It also boasts the longest median follow-up duration. The use of validated questionnaires, a uniform and specified sphincter repair technique, and analysis of results using the validated end point of meaningful clinical difference to define post op success improve the strength of the conclusions that are able to be drawn from this study.
The retrospective observational nature of this study is a key limitation. Recall bias with subsequent questionnaires and the subjective nature of patient reported outcomes another limitation.