Overlapping sphincter repair: does age matter?

BACKGROUND The predictors of the outcomes following anal sphincteroplasty have not been well documented. OBJECTIVE The aim was to evaluate age as a predictor of functional outcome and quality of life after overlapping sphincter repair. DESIGN This study is a retrospective review of chart review followed by a prospective evaluation by the use of validated questionnaires. SETTINGS Patients were assigned to group A (≤ 60 years old) or group B (>60 years). PATIENTS Included were patients with obstetric sphincter injuries who underwent overlapping sphincteroplasty between 1996 and 2007. MAIN OUTCOME MEASURES The Fecal Incontinence Quality of Life Scale, Fecal Incontinence Severity Index, the Cleveland Global Quality of Life scale, and a patient satisfaction questionnaire were used to assess outcome. RESULTS Three hundred twenty-one women underwent sphincteroplasty and 197 responded to this study, 146 (74.1%) patients in group A and 51 (25.9%) patients in group B. Median follow-up was 7.7 years (range, 4.7-10.0). The mean overall Fecal Incontinence Quality of Life Scale was 11.0 ± 3.5. Median Fecal Incontinence Severity Index score was 29.8 ± 15.9. Mean Cleveland Global Quality of Life scale was 0.7 ± 0.2. The 2 groups were comparable for BMI (p = 1.0), ethnic background (p = 0.8), smoking (p = 0.8), and follow-up duration (p = 0.9). Intergroup comparison showed no significant difference in the Fecal Incontinence Quality of Life Scale scores (p = 0.5) in all subscales: lifestyle (p = 0.8), coping behavior (p = 0.5), depression and self-perception (p = 0.2), and embarrassment (p = 0.1). No significant differences were noted in Fecal Incontinence Severity Index (p = 0.2), Cleveland Global Quality of Life scale (p =1.0), or postoperative satisfaction (p = 0.6). LIMITATIONS The study was limited by its retrospective nature. CONCLUSIONS Comparable long-term Fecal Incontinence Severity Index score and Fecal Incontinence Quality of Life Scale scores following overlapping sphincter repair suggest that age is not a predictor of outcome for overlapping sphincter repair. This procedure can be offered to both young and older patients.