Options emerge for fecal incontinence, but results uncertain for long term.(Gynecology)

FORT LAUDERDALE, FLA. -- Anterior overlapping sphincter repair is commonly performed in patients with fecal incontinence secondary to an anterior defect in the sphincter complex, but long-term outcomes are questionable.

In the short term, 50%-75% of patients achieve good control of solid and liquid bowel movements. But the limited data available on long-term outcomes are less promising, Eric G. Weiss, M.D., said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

Few of the patients requiring such surgery--usually as a result of obstetric or iatrogenic trauma--have good long-term function, said Dr. Weiss of Cleveland Clinic Florida, Weston.

In one study of 42 patients who underwent the surgery, half were continent after the surgery, and only 14% were continent at a 6-year follow-up. In another study of 191 patients, 40% had some continence, but only 6% had complete continence at 10-year follow-up.

One factor that has emerged as a predictor of poor surgical outcome is the presence of neuropathy, he noted.

In patients who don't do well following surgery, consider whether the repair was successful from an anatomic standpoint, he advised.

Ultrasound can help determine whether the sphincter repair is intact or if there is a persistent defect. A second attempt at surgical repair may be warranted in cases of persistent defect, but if the initial repair is intact, an alternative procedure should be considered, Dr. Weiss said.