Levatorplasty using a posterior sagittal approach in secondary faecal incontinence

Abstract

Levatorplasty has been used successfully in children with secondary faecal incontinence. A posterior sagittal approach in anorectal anomalies gives excellent delineation of the anatomy of the pelvic floor and perineum. Between August 1985 and December 1989, 13 children underwent levatorplasty using a posterior sagittal approach for faecal incontinence following primary operations for imperforate anus. There were 9 boys and 4 girls; 7 of them had a major associated anomaly. Twelve patients had a high anorectal anomaly and the primary operation was a sacro-perineal or sacro-abdomino-perineal pull-through. One had an intermediate anomaly treated by a perineal operation. All patients had persistent soiling and among them had 27 further unsuccessful operations to improve continence prior to posterior sagittal levatorplasty. Six patients had good and 7 had poor to moderate voluntary squeeze pressures prior to levatorplasty. Age at posterior sagittal levatorplasty ranged from 4 to 17 years (mean 10.7 years). All patients were followed up for periods ranging from 2 years 2 months to 6 years 5 months (mean 4.7 years). At least review 6 patients (46%) had excellent results with full continence and no soiling; 5 (39%) showed significant improvement compared with the pre-operative state with occasional soiling only. Of these, 3 patients opted for total colonic irrigation once a day to remain clean at all times. Two patients (15%) had poor results with frequent soiling. The posterior sagittal approach provides excellent exposure for levatorplasty. Best results were obtained in patients who had good voluntary squeeze pressures on anorectal manometry prior to the operation.