Results
107 women had AS repairs and were included in the study, 9 women had
concurrent fistula repairs and were analysed as a separate group. 10
women were lost to follow up leaving 88 women for analysis.
<Fig1. Patient flow diagram>
82 women of the total group of 88 women had follow-up of greater than 6
months. Median follow-up time was 57.5 months (IQR: 24.7–81.9).
Demographic characteristics are presented in Table 1.
<Table.1>
There was a significant reduction of the median St Marks score
preoperatively of 17 compared to a postoperative score of 10
(p<0.001).
69.3% of women had a St marks score with a clinically meaningful
improvement of more than 5 points. Out of these 46.5% of women had a
marked improvement of their incontinence with < 1 occurrence
of faecal incontinence per month. 70 % of patients would recommend the
procedure to a friend (Table 2).
<Table 2>
Our patients’ symptoms deteriorated with time when comparing short term
follow up and Long term follow up. Changes in faecal urgency, faecal,
liquid and flatal incontinence are shown in table 3.
<Table3>
Post-operative wound infection was reported by 45% of patients (40/88)
with some form of perineal breakdown in 27% (24/88). Infection or
breakdown did not seem to impact outcomes of the repair with significant
improvement in the St mark score, similar to the scores of women in the
overall group. These women were also as likely to recommend the
procedure to a friend.
<Table 4>
16 patients had an endoanal ultrasound (EAUS) following their AS repair.
Of these 68.7% had a persistent sphincter defect, 5 of 16 patients had
a no defect. Patients with a persistent sphincter defect still
demonstrated a significant improvement in the St marks score.
<Table 5>
Two of our women underwent a repeat sphincter repair. Both of these
women later went on to having Sacral neuro modulation (SNS). Three other
women went on to have SNS; one who gained significant improvement, the
other two without significant change in the bowel function. Two women
had an anal bulking agent injection following their sphincter repair
without any improvement in their bowel function. Two women underwent a
Fenton’s repair for dyspareunia. One patient had wound breakdown and
developed a rectovaginal fistula post operatively.
The 9 patients with concurrent AS repair and rectovaginal fistula all
had a sphincter defect on pre-operative ultrasound. This group had a
higher post-operative ST Marks score compare to the AS repair alone.
Five of these 9 women had a significant improvement in their ST Marks
score. All of the women with a concurrent fistula repair had successful
fistula closure and had some form of wound infection and perineal
breakdown as reported by the patient.
< Table 6>