Primary Sphincter Repair: Are the Results of the Operation Good Enough?

Excerpt

To the Editor—I read the article by Pinta et al.1 with interest, but was disappointed by the poor design of the study, which resulted in an extensive collection of irrelevant results. The study was generally based on a comparison of a retrospective group of females with third-degree and fourth-degree tears and a prospective group of primiparous females with no clinical detectable perineal laceration after vaginal delivery. Right at the onset, these two groups were fundamentally different and not comparable. It was, therefore, not surprising to the reader to find symptoms of anal incontinence significantly worse in the former group. Despite this fundamental flaw, 61 percent of patients did complain of symptoms of alteration of incontinence after primary sphincter repair of their third-degree and fourth-degree tears. This result did emphasize the well-known poor-to-mediocre success rates.2, 3 However, because the follow-up period (2–144 months) was extremely broad, it was difficult to extrapolate whether these were early or late failures. Although I agree with the logical conclusion that patients should be thoroughly reassessed every six months and in symptomatic cases referral to a proctologist pursued, one must remember that delayed repair of anal sphincters also are plagued with average results.4 It may nevertheless be that such a proactive, multidisciplinary approach may prevent further decompensation of continence mechanisms and subsequently better overall results. …