Int Urogynecol J. 2023 Feb;34(2):527-534. doi: 10.1007/s00192-022-05269-4.Epub 2022 Jun 23.

Frida Carswell ¹, Peter Dwyer ², Ariel Zilberlicht ², James Alexander ², Madhu Bhamidipaty ³, Alison Desousa ², Jamie Keck ⁴, Alex Wong ⁴, Lore Schierlitz ²

Author information

¹Urogynaecology Department, Mercy Hospital for Women, Heidelberg, VIC, Australia. fridacarswell@gmail.com.

²Urogynaecology Department, Mercy Hospital for Women, Heidelberg, VIC, Australia.

³Department of Surgery, St Vincent's Hospital, Melbourne, VIC, Australia.

⁴Department of Surgery, Eastern Health, Box Hill, VIC, Australia.

Abstract

Introduction and hypothesis: We report our experience with a transvaginal approach with overlapping anal sphincter repair. The aim of this cohort study was to evaluate long-term functional outcomes. Women who had undergone transvaginal anal sphincteroplasty for anal incontinence from July 2005 to July 2020 and attended a multidisciplinary team of urogynaecologists and colorectal surgeons at the Mercy Hospital Perineal clinic were included.

Methods: One hundred seven women were included in the study with a median follow-up of 57.5 months. We analysed outcomes by comparing patient's St Mark's score difference before and after surgery. Meaningful clinical difference (MID) was set at 5 points; complications and patient demographics were recorded along with a question about whether they would recommend this treatment to a friend.

Results: An improvement was seen in 69.3% of women with a marked improvement in 46.5%. Furthermore, 70% said they would recommend the procedure to a friend, if they were in a similar situation. Wound infection or partial perineal breakdown was reported in 45% of women but did not have a significant impact on outcomes.

Conclusion: Transvaginal anal sphincter repair is associated with significant improvements in patients' St. Mark's score. Our data show that the long-term success rate of transvaginal/perineal AS repair may be better than previously reported in the literature with 70% of women satisfied at 57 months. Another benefit of the transvaginal route is the possibility of performing a pelvic floor and perineal repair at the time of surgery.