Long-term Fecal Incontinence, Recurrence, Satisfaction, and Regret After the Transobturator Postanal Sling Procedure

Winkelman WD1,2, Demtchouk VO3,1,2, Brecher LG4, Erlinger AP1, Modest AM, Rosenblatt PL3,1,2. Female Pelvic Med Reconstr Surg. 2019 Aug 15. doi: 10.1097/SPV.0000000000000769. [Epub ahead of print]


Author information

Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center.

Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School.

From the Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge.

Department of Obstetrics and Gynecology, Tufts Medical School, Boston, MA.


OBJECTIVES: The objective of this study was to assess long-term outcomes after the transobturator postanal sling (TOPAS) procedure for the treatment of fecal incontinence. Long-term recurrence, satisfaction and regret after transobturator postanal sling procedure support the ongoing use of this procedure for patients with fecal incontinence.

METHODS: Both a retrospective review of medical records and a prospective telephone survey were conducted. For the retrospective review of medical records, all patients who underwent the TOPAS procedure at our institution were eligible. Medical records were reviewed to assess for symptom resolution, retreatment, and complications. For the prospective telephone survey, patients who were conversant in English and had a valid contact information were eligible and were asked to complete questions on satisfaction, the Patient Global Impression of Improvement, the Wexner Symptom Severity Score, the Fecal Incontinence Qualify of Life Scale, and the modified Decision Regret Scale.

RESULTS: A total of 134 patients met the inclusion criteria for the retrospective medical record review. Patients were followed in clinic for a median of 24.0 months (interquartile range, 6.0-53.0). Overall, 75.4% reported improvement in fecal incontinence. There were 37 (27.6%) who required subsequent treatment for fecal incontinence. There were 67 patients eligible for the prospective telephone survey, of whom 46 (68.7%) agreed to participate. Median time between surgery and the telephone survey was 63.5 months (interquartile range, 36.0-98.0). Among these participants, 54.3% were satisfied and 60.9% would recommend the procedure to someone else. No adverse events were identified with long-term follow-up.

CONCLUSIONS: Our findings suggest that the TOPAS procedure remains a safe and effective therapy for the treatment of fecal incontinence with favorable long-term outcomes.

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