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Clark CL, Wilkinson KH, Rihani HR, et al. Peri-operative management of patients having external anal sphincter repairs: temporary prevention of defaecation does not improve outcomes. Colorectal Dis. 2001;3(4):238-44doi: 10.1046/j.1463-1318.2001.00246.x.
Clark, C. L., Wilkinson, K. H., Rihani, H. R., McDonald, P. J., Northover, J. M., & Phillips, R. K. (2001). Peri-operative management of patients having external anal sphincter repairs: temporary prevention of defaecation does not improve outcomes. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 3(4), 238-44. https://doi.org/10.1046/j.1463-1318.2001.00246.x
Clark, C L, et al. "Peri-operative management of patients having external anal sphincter repairs: temporary prevention of defaecation does not improve outcomes." Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland vol. 3,4 (2001): 238-44. doi: https://doi.org/10.1046/j.1463-1318.2001.00246.x
Clark CL, Wilkinson KH, Rihani HR, McDonald PJ, Northover JM, Phillips RK. Peri-operative management of patients having external anal sphincter repairs: temporary prevention of defaecation does not improve outcomes. Colorectal Dis. 2001 Jul;3(4):238-44. doi: 10.1046/j.1463-1318.2001.00246.x. PMID: 12790966.
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Colorectal Dis. 2001 Jul;3(4):238-44. doi: 10.1046/j.1463-1318.2001.00246.x.

Peri-operative management of patients having external anal sphincter repairs: temporary prevention of defaecation does not improve outcomes.

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

C L Clark, K H Wilkinson, H R Rihani, P J McDonald, J M Northover, R K Phillips

Affiliations

  1. St Mark's Hospital, Harrow, UK. [email protected]

PMID: 12790966 DOI: 10.1046/j.1463-1318.2001.00246.x

Abstract

OBJECTIVE: To determine whether there was any detectable difference in outcomes of external anal sphincter repair depending on whether patients were managed routinely with a covering stoma, a constipating dietary regimen or a laxative dietary regimen in the early postoperative period.

PATIENTS AND METHODS: A consecutive retrospective series of 299 anal sphincter repairs undertaken on 286 patients within a single institution was studied. Patients were divided into three groups depending on the peri-operative regimen followed: routine use of a covering stoma (group 1), routine use of a postoperative constipating dietary regimen (group 2) and routine use of a laxative dietary regimen (group 3). Choice of peri-operative regimen depended on surgeon preference alone. Short-term outcomes (length of stay, complications) and long-term outcomes (functional reported degree of continence, anal ultrasound and physiology test results) were assessed in relation to peri-operative group as well as aetiology of sphincter damage.

RESULTS: Short-term results (complications of surgery) were obtainable in all patients; long-term results were available for 89% of patients. Length of stay was similar for all 3 groups (excluding re-admission for stoma closure). Complication rates were not significantly different between the three groups. Functional improvement in continence was reported by 68% of group 1, 69% of group 2 and 79% of group 3 (differences not statistically significant). An anatomical sphincter defect was detected postoperatively in 8% of patients in group 1, 9% in group 2 and 7% of group 3. Poorer outcomes were achieved in older patients and in patients with previous ileo-anal pouch formation. Early faecal impaction and repair breakdown were independently associated with poor long-term outcomes.

CONCLUSIONS: Neither routine use of a covering stoma nor a postoperative constipating regimen produced better results following external anal sphincter repair than did the use of a postoperative laxative regimen which encouraged early passage of loose stool without the need for straining.

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