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Objective: To evaluate the long-term results after postanal repair in patients with faecal incontinence., Design: Retrospective study., Location: Rotterdam., Methods: Thirty-seven patients, who underwent postanal repair during the period 1984-1992, were approached by telephone to determine the current functional status., Results: The median duration of follow-up was 38 months (range: 4-94). One year after the operation 24 patients (65%) were continent. In 22 patients this successful outcome was observed within the first half year. In seven patients (29%) incontinence recurred. In 13 patients (35%) the functional results were disappointing from the very beginning. The final outcome, which was good in 46% of the patients, was not influenced by the underlying aetiology., Conclusion: Postanal repair is not beneficial for the majority of patients with faecal incontinence. Therefore, it should be considered if other treatment modalities, such as biofeedback and the electrically stimulated M. gracilis neosphincter might not be preferable.

During the last 5 years 33 patients with faecal incontinence due to childbirth were investigated. Ages varied from 23 to 61 and duration of symptoms from 0.3 to 25 years. Anal manometry was performed in all patients and electromyography was performed in 21 cases. Twenty-seven patients underwent delayed sphincter repair. Continence was restored in 21 (81%). Post-operatively performed EMG in the patients who remained incontinent demonstrated severe denervation but sphincter mapping did not demonstrate muscle discontinuity. Continence improved in three patients within one year as results of reinnervation. Faecal incontinence after childbirth may be due to either obstetric rupture or denervation. Both disorders may coexist. Sphincter repair gives excellent results provided denervation is not present. Preoperative assessment by EMG is mandatory.

Evaluation of anorectal function in faecal incontinence. In cases presenting faecal incontinence, an etiological diagnosis should be based on history, clinical examination, anuscopy and rectoscopy. This diagnosis should be confirmed or contradicted by the results of objective investigations, especially manometry, myography and radiology. In the absence of anorectal anatomical defects, a functional cause of incontinence has to be found: megarectum with pseudo-incontinence, psychogenic encopresis, lesions of the nervous system, pudendal neuropathy. In the presence of obvious anatomical defects, the function of all components of the anorectal continence apparatus has to be evaluated; in this way, it will be possible to objectivate the results of conservative or surgical treatment by repetition of the technical investigations. In practice, a complete functional evaluation of the anorectum has to be performed in patients in whom the results of previous therapy remain unsatisfactory.