OP23.06: Defects and anal incontinence after primary repair of 4th degree sphincter rupture: an endo-anal study of the sphincter complex and the m. puborectalis

Objectives: The aim of this study was to look for a possible correlation between anal incontinence (AI) and 3D ultrasonic defects after primary repair of 4th-degree anal sphincter ruptures (ASR). Furthermore, the aim was to measure the thickness/length of the m. puborectalis and the length of the anal canal to investigate if any of these parameters correlated with AI. Methods: A validated, symptom specific questionnaire on AI including the St Marks and the Wexner score was sent to 84 consecutive women, who were registered with a 4th-degree anal sphincter rupture (ASR) at our institution between 1 January 2000 and 31 December 2005 (follow up time 12–72 months). Sixty-five women returned the questionnaire (77%) and 36 (43%) gave written informed consent to have ultrasound performed (EAUS). A 3D B-K Medical pro focus machine with a 2050 13-MHz probe was used. Images were analyzed using Starck score (0–16). Results: There was no difference in incontinence score in women with and women without EAUS examination. The distribution of symptoms among the 36 women participating in the EAUS examination: Eleven women were continent (31%), fifteen (42%) had flatus incontinence, seven (19%) had incontinence for liquid stool and flatus and three (8%) were incontinent for hard stool, liquid stool and flatus. Eighteen (50%) had urgency. Clear images of the anal sphincter anatomy was obtained in all 36 women. A weak correlation between the St Marks and sphincter defects scores was demonstrated. All women with a St Marks score > 8 had sphincter defects on ultrasound > 13. The length of the m. puborectalis was independent of the length of the anal canal. A weak correlation between the thickness of the m. puborectalis and the Starck defect score was found. However, no correlation between AI and thickness of the m. puborectalis could be demonstrated. Conclusions: A weak correlation in a 6-year follow-up period was seen between St Marks score and ultrasound sphincter defect score. All patients with St Marks score > 8 had ultrasound defects > 13.