Correlação da incontinência fecal com parâmetros clínicos, funcionais e anatômicos de pacientes do sexo feminino submetidas à secção da musculatura esfincteriana lisa pós fistulotomia anal e esfincterotomia anal

Abstract

Introduction: Anal fistula and anal fissure are benign diseases affecting the anal canal; however, surgical treatment may be required, often involving division of the internal sphincter muscle. As a consequence, patients may experience sequelae that significantly impact their quality of life, such as fecal incontinence, with female patients being particularly susceptible. Methodology: Sixty-three female patients who underwent internal sphincter muscle division through anal fistulotomy (30 patients) or anal sphincterotomy (33 patients) were evaluated. Clinical assessment was performed using a fecal incontinence score, functional assessment by anorectal manometry, and anatomical assessment by 3D endoanal ultrasound. Results: Overall, 46% (29/63) of patients reported symptoms of fecal incontinence after internal anal sphincter division, with 18 (60%) in group I and 16 (48%) in group II. However, the severity of symptoms was similar between groups, with mean scores of 1.6 (0–8) in group I and 2 (0–7) in group II. Resting pressure decreased in both groups and was similar between them postoperatively. The longitudinal length and percentage of the internal sphincter muscle divided were greater in group I. The longitudinal length of the anterior external anal sphincter and the distance between the external anal sphincter and puborectalis muscle were similar in both groups. However, the gap length—the distance between the proximal edge of the external anal sphincter and the distal edge of the puborectalis—was significantly greater in group II. Conclusion: Sphincter division surgery, regardless of the operative technique, is associated with a high rate of fecal incontinence, although the symptom severity remains low. The length and percentage of smooth muscle divided were smaller in patients who underwent anal sphincterotomy. Nevertheless, the rate of fecal incontinence was similar between the two groups. This finding may be explained by the longer gap observed in this group, leading to greater asymmetry of the anal canal.