Evaluación de los resultados de la Esfinteroplastia Anatómica mediante la reconstrucción combinada del esfínter anal interno y externo en el tratamiento quirúrgico de la incontinencia anal

Overlapping anal sphincter repair is usually advocated for the treatment of fecal incontinence due to obstetrical, iatrogenic or accidental damage. The classic technique includes overlapping of the external anal sphincter with preservation of scar tissue and without attempting to separate the internal from the external sphincter muscles. Several studies show improvement of 75% of patients treated in a short-term follow-up, with a worsening of this data in the long-term follow-up down to an improvement of 50% of the patients. Some other groups published more optimistic results, showing an 80% success rate without any deterioration of the technique over time after introducing a separate repair of the internal and external muscles. Nevertheless, this latest technique has not popularized and further studies are needed to confirm these results. Aims: The introduction of some modifications in the classic technique, named “Anatomic sphincteroplasty with combined reconstruction of external and internal anal sphincter muscles” may improve the clinical and anorectal manometric results both in a short and long-term follow-up. The purpose of this study is to describe the surgical technique in order to be reproducible, to evaluate its safety and the results of this new surgical technique in a mid and long-term follow-up and to assess the possible deterioration over time. Methods: A prospective longitudinal study was conducted including patients between January 2008 and December 2018 who underwent to an “Anatomic combined sphincteroplasty of external and internal anal muscles” due to a sphinteric defect. Cleveland Clinic Score, a modification of that scale including soiling, Fecal Incontinence Quality of Life Scale, patient’s satisfaction, ultrasound and manometric study were assessed in all patients. We evaluated these data in short, mid and long-term and also stablished comparisons between preoperative and postoperative data. Results: Forty patients were included, with 27.5 months of median follow-up. The Cleveland Clinic Score lowered from 15.5 to 3 and the modified score from 19 to 3, p<0.001. Ninety-five per cent of excellent or good results were obtained. An improvement of every item in the Fecal Incontinence Quality of Life was found with statistical significance and 92.5% of patients were satisfied or very satisfied after surgery. An increase of maximal basal pressure from 25 mmHg to 60mmHg and an increase of maximal squeeze pressure from 40 to 100 mmHg (p<0.001) were noted. Anal ultrasound showed a correct sphincter restoration in 65.7% of the patients. The same variables were measured at 11.5 and 37.5-month follow-up and did not show any worsening over time. A 20-patient subgroup was analyzed with a 55-month follow-up assessing the same results obtained in the short-mid-term follow-up. Conclusions: The “Anatomic sphincteroplasty with combined reconstruction of internal and external anal muscles” has excellent clinical and functional results in short and long-term follow-up. No deterioration over time was found.