Publication:

Managing traumatic anal sphincter injuries without the use of endo-anal ultrasound: an experience with 29 patients presenting to the surgery department at a tertiary care centre in North India

Background Endosonography is the method of choice for pre-operative imaging of External Anal Sphincter (EAS), having established its role in identifying sphincter defects. We present here results of sphincter repair done in traumatic external sphincter defects with clinical examinations as the only pre-operative tool, to evaluate and map the sphincter defect as well as to assess the probability of success of the repair.

Methods The data has been collected from an ongoing prospective study over a period of 5 years (2008 -2013) in patients with fecal incontinence secondary to traumatic anal sphincter injuries detected during initial presentation in acute setting. Clinical assessment was used in isolation to diagnose EAS defect. Contraction of the sphincter on inspection and per rectal examination was done to assess the location of the defect. All patients underwent the usual overlapping sphincter repair with covering stoma under general anesthesia. The location and size of the defect found during surgery was recorded and compared with the clinical findings.

Results Cohort of 29 patients over a period of 5 years (2008-2013) with traumatic sphincter injury were included in this study who underwent overlapping sphincter repair. (21/29) patients were male patients, road traffic accidents was the most common etiology (23/29) followed by sphincter complex injury related to obstetric and gynaecological procedure (5/29). Majority of patients were managed with fecal diversion (27/29).  (24/27) patients had their stoma’s reversed and were fully continent. 8 patients developed anal stenosis managed with repeated self-anal dilatation on follow-up.

Conclusions Pre-operative clinical assessment with intra-operative assessment of the site of sphincter injury is a good clinical tool in detecting the size and site of the defect for surgical repair of injured anal sphincter without using endoanal ultrasonography.