Abstract

Objective

To characterize variants of anal sphincter insufficiency after surgical repair of obstetric injury and assess differentiated treatment outcomes. 
 

Materials and Methods

This single-center cohort included 86 women aged 18-45 years operated on in 2021-2024 and followed through 2026. Mean age was 34.3±5.2 years. Recurrence was defined as secondary loss of an achieved result, a residual variant as persistent structural defect after incomplete reconstruction, and a mixed variant as structural insufficiency with objective neuromuscular dysfunction. Assessment included the Wexner score, three-dimensional endoanal ultrasonography, indicated magnetic resonance imaging, high-resolution anorectal manometry, electromyography, and pudendal nerve terminal motor latency. Outcomes were assessed at 12-24 months. 
 

Results

The recurrent variant was identified in 28 women (32.6%), the residual variant in 22 (25.6%), and the mixed variant in 36 (41.8%). At 6 months, the Wexner score decreased from 11.8±3.0 to 5.5±2.8, resting pressure increased from 34.6±8.7 to 48.9±9.5 mmHg, and maximum squeeze pressure increased from 71.4±18.2 to 102.7±20.4 mmHg (all p<0.001). External anal sphincter continuity was restored in 75 of 86 women (87.2%). Complete continence was achieved in 52 women (60.5%; 95% CI 49.9-70.1%), whereas 8 women had an unfavorable functional result (9.3%; 95% CI 4.8-17.3%). The final Wexner score was lowest in the residual group: 3.2±1.7 versus 5.6±2.4 in the recurrent group and 6.8±2.9 in the mixed group (p<0.001). Recurrent insufficiency occurred in 14.3%, 9.1%, and 27.8%, respectively (p=0.177). 
 

Conclusion

The three variants clarify prior surgical failure and may guide repeat treatment. Less favorable mixed-group outcomes require cautious interpretation and external validation.
 

Keywords

fecal incontinence; anal sphincter; obstetric injury; sphincteroplasty; recurrence; residual defect; neuromuscular dysfunction.

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