Long-term outcomes of anal sphincter repair for fecal incontinence: A systematic review

BACKGROUND: Thorough and objective analysis of longterm results following anal sphincter repair for fecal incontinence will permit the correct application of this operation in the context of newer treatment methods. OBJECTIVE: This investigation aimed to comprehensively review outcomes beyond 5 years in patients undergoing anal sphincter repair for fecal incontinence. DATA SOURCES: A systematic review of Embase and MEDLINE articles published between January 1991 and December 2010 was conducted; additional studies were identified by hand-searching bibliographies. STUDY SELECTION: A 2-step process was used for screening articles examining sphincter repair or sphincteroplasty in adults with fecal incontinence, with a minimum follow-up of 60 months. MAIN OUTCOME MEASURES: Subjective or objective assessment of fecal incontinence in the postoperative period was completed. RESULTS: Data from 16 studies were examined, comprising nearly 900 repairs. There was significant heterogeneity in outcome measures, although most articles utilized at least one established incontinence instrument. In general, most series reported an initial subjectively "good" outcome in the majority of patients, with declines in this proportion over longer follow-up. There was poor correlation between quality of life and the severity of fecal incontinence, with all articles reporting high overall patient satisfaction even if continence declined with time or adaptive measures were needed. No consistent predictive factors for failure were identified. LIMITATIONS: This study was limited by the paucity of level I data with an adequate length of follow-up. CONCLUSION: Despite worsening results over time, most patients remain satisfied with their surgical outcome postsphincteroplasty. Efforts should be directed at identifying patients who may do poorly following sphincter repair, as well as establishing standardized long-term outcome benchmarks for comparing novel techniques for treating fecal incontinence.