Int J Colorectal Dis (2006) 21: 52–56 DOI 10.1007/s00384-004-0737-7 ORIGINAL ARTICLE Goran I. Barisic Zoran V. Krivokapic Velimir A. Markovic Milos A. Popovic Accepted: 15 December 2004 Published online: 14 April 2005 # Springer-Verlag 2005 Outcome of overlapping anal sphincter repair after 3 months and after a mean of 80 months Abstract Background: The aim of this study was to determine the functional results of anal sphincter repair after a long follow-up (mean 80.1 months). Methods: In the period 1990–2002, 65 sphincter repairs were performed. Obstetric trauma was the cause of incontinence in 72.3% cases, fistulotomy in 13.8%, nonspecific trauma in 9.2%, and war injury in 4.6%. At the time of surgery, 12 patients had undergone an urgent stoma procedure. In all cases, anal manometry, electromyography, and defecography were performed. The severity of incontinence was evaluated preoperatively using the Wexner score system. Anterior sphincteroplasty was performed in 52 cases, lateral in 9 cases, and posterior in 4 cases. Results: The results were determined according to the Wexner score system and the Browning–Parks scale. The Wexner score was calculated 3 months after operation and during every follow-up visit. Preoperative scores and those at the first and last follow-up visits were analyzed. Three months after operation excellent results were achieved in 55.5%, good in 18.5%, fair in 16.9%, and poor in 9.2% patients. After follow-up (mean 80.1 months), 26.8% had excellent results, 21.4% had good results, 12.5% had fair results, and 39.3% of patients had a poor outcome. Results determined by the Wexner score system improved from 17.8 preoperatively to 3.6 three months after operation, but deteriorated over time to 6.3 after longer follow-up (p<0.001). Conclusion: Overlapping sphincter repair provides satisfactory results in more than two-thirds of patients initially, but the results tend to worsen over time and are satisfactory in half of patients after longer follow-up. Keywords Fecal incontinence . Sphincter repair . Quality of life Introduction Severe anal incontinence is a distressing condition and dif- ferent treatment modalities adapted to the severity of the handicap are available [1]. For patients with obstetric in- juries to the anal sphincter, sphincteroplasty is the most logical treatment option, even though some patients with anatomic defects have been reported to benefit from bio- feedback alone [2]. The aim of this study is to evaluate the functional results of overlapping anal sphincter repair after longer follow-up. Materials and methods In the period 1990–2002, 65 anal sphincter repairs were performed in the Third Department of Colorectal Surgery, First Surgical Clinic, Belgrade, by the same surgeon or under his supervision. There were 55 women and 10 men. The mean age was 35.9 years (range 18–64). All patients had complete fecal incontinence (incontinent for liquid and solid stools) or colostomy performed at the time of injury, and none of them had had previous anal sphincter repair. At the time of surgery, 12 patients had undergone an urgent G. I. Barisic . Z. V. Krivokapic . V. A. Markovic . M. A. Popovic Institute for Digestive Diseases, First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia and Montenegro Z. V. Krivokapic (*) First Surgical Clinic, Koste Todorovica 6, 11000 Belgrade, Serbia and Montenegro e-mail: scpy@beotel.yu Tel.: +381-11-3031830 Fax: +381-11-3031830