Effect of age, patient’s sex, and type of trauma on the correlation between size of sphincter defect and anal pressures in posttraumatic fecal incontinence Sameh Hany Emile, MD, Mohamed Youssef, MD, Hossam Elfeki, MSc, Waleed Thabet, MD, Hesham Elgendy, MD, Waleed Omar, MD, Wael Khafagy, MD, and Mohamed Farid, MD, Mansoura, Egypt Background. The physiologic assessment of anal sphincters in cases of posttraumatic fecal incontinence is a fundamental step in planning operative treatment. In this study, we evaluate the correlation between size of anal sphincter defect, anal pressures, and clinical symptoms in patients with posttraumatic fecal incontinence. We also investigate the impact of patients’ age, sex, and type of trauma on this correlation. Methods. Records of 70 patients fitting the study’s eligibility criteria were collected retrospectively from the archives of Mansoura University Hospitals’ colorectal surgery unit. Demographic data of patients, causes of fecal incontinence, images of sphincter defects on endorectal ultrasonography, anal resting and squeeze pressures, and Wexner continence scores were collected, and correlation analysis was performed. Results. Seventy patients (54 males and 16 females) with a mean (±standard deviation) age of 36 ± 16 years were studied. Mean maximal resting anal pressure was 42 ± 16 mm Hg, and mean maximal squeeze anal pressure was 80 ± 35 mm Hg. Size of external anal sphincter defect was negatively correlated with mean maximal squeeze (r = À0.4298). Mean Wexner continence score was correlated positively with size of external anal sphincter defect (r = 0.3743). Both correlations became significantly stronger in female patients, patients greater than 50 years, postfistulectomy patients, and patients with obstetric injuries. Conclusion. Size of external anal sphincter defect correlates negatively with mean maximal squeeze and positively with symptoms score. This correlation is stronger in females, patients greater than 50 years, and patients with postfistulectomy or obstetric injuries. These findings suggest that this group of patients requires additional assessment before surgical repair. (Surgery 2016;j:j-j.) From the Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt FECAL INCONTINENCE (FI) is defined as the contin- uous or intermittent absent control of passage of >10 mL of fecal material for at least 1 month in an individual >3 years. 1 FI represents a socially disabling condition with a markedly negative impact on patient quality of life. 2 Three main types of FI exist: (1) passive incontinence, (2) urge in- continence, and (3) fecal soiling. 3 There are various causes for FI, including neurologic conditions, traumatic conditions, in- flammatory bowel disease, and rectal prolapse. Among the causes of FI, traumatic conditions causing damage to the anal sphincters have the greatest prevalence among causes of FI. Traumatic injury of the anal sphincters may occur after anorectal surgery, obstetric trauma, or other trau- matic injuries such as after a road traffic accident. 4,5 Severity of FI is related to 3 essential factors: (1) frequency of incontinence, (2) type of FI, and (3) volume of fecal material lost. 6 Management of post- traumatic FI requires careful assessment of the con- dition and function of the anal sphincter. Standard investigations include anorectal manometry to eval- uate the function of anal sphincter muscles, rectal Accepted for publication May 19, 2016. Reprint requests: Sameh Hany Emile, MD, Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura 35516, Egypt. E-mail: sameh200@hotmail.com. 0039-6060/$ - see front matter Ó 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2016.05.020 SURGERY 1 ARTICLE IN PRESS