Prognoses of injury scale in surgical treatment of post-traumatic anal incontinence

AIM: to evaluate the predictive value of endorectal ultrasound (ERUS) and transperineal ultrasound (TPUS) in surgical treatment of post-traumatic anal incontinence (AI).

PATIENTS AND METHOD: it was a prospective two-center study. The study enrolled 35 women with obstetric perineal trauma followed by anal incontinence, who underwent delayed reconstruction of the sphincter-levator complex in the period 2019–2022 at the Lomonosov Moscow State University Research and Educational Center. Preoperatively ERUS and TPUS was conducted. All patients underwent overlap sphincteroplasty with subsecuent follow up. After surgery all patients were asked to fill online-forms with questions from Wexner Incontinence Score, FIQL and PISQ-12 score. Satistical evaluation with correlation analysis was performed.

RESULTS: the patients’ mean age was 33 years (SD = 5), the number of births varied from 1 to 3, and the mean time from symptom onset to specialist visit was 39 months (range: 0–240 months). Defects in the external anal sphincter (EAS) counted 47 to 116 degrees. The range of defect sizes in the internal anal sphincter (IAS) ranged from 76 to 177 degrees. The average follow-up period for patients was 7 months, with a maximum period of 4 years. The average degree of incontinence according to the Wexner Incontinence Score and quality of life according to the FIQL and PISQ-12 scale before the intervention were 13 (SD = 3.5), 1.9 (SD = 0.5) and 17 (SD = 6.8), respectively. After the treatment, the scores were 2,8(SD = 2,9), 3,6(SD = 0,6), 8,2(SD = 3,5). No correlation was found between ultrasound parameters and the results of the incontinence grade and quality of life scores.

CONCLUSION: the effectiveness of surgical treatment of postpartum anal incontinence did not depend on the size of the internal or external sphincter defect, as well as on other factors obtained by ultrasound diagnostics.

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