From 1989 to 1993, 35 consecutive patients with fecal incontinence were evaluated with anal manometry, EMG and anal endosonography. According to the etiology (neurogenic, traumatic, etc.) and the degree of incontinence (mild, moderate, severe), 19 of them were treated conservatively with biofeedback training and 16 underwent surgery for a total of 20 procedures (6 postanal repair, 11 sphincteroplasty, 3 gracilis neosphincter operations). Mean follow-up was 21 months; success rate of biofeedback was 84.2%. Overall, 12 patients were clinically improved after surgery (75%), with complete continence restored in 5 (31.2%). Complications occured in 2 cases (12.5%). Satisfactory results were obtained in 50% of cases after postanal repair (34% of failures) and in 73% after direct sphincter repair. Sphincteroplasty failed in 3 patients (27%), These subsequently underwent gracilis muscle transposition. with long-term electrostimulation: 2 of them are totally continent and 1 patient is still under neurotraining. Anal endosonography is the procedure of choice for mapping the anal sphincters in traumatic incontinence. It is useful in planning the best type of operation and in auditing the results of surgery. Multidisciplinary approach is essential in the management of fecal incontinence: whenever performed for correct indications, both conservative and surgical treatment yield excellent cure rates. Dynamic graciloplasty is a complex and esoteric reconstructive technique to be reserved to highly selected patients; nonetheless it is effective and may well be the only chance for patients who would otherwise be doomed to a permanent colostomy.
|Number of pages||7|
|Publication status||Published - 1995|
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