A Cochrane review [Abstract] 1 included 9 studies with a total of 264 subjects. Two trials included a group managed non-surgically. One trial compared levatorplasty with anal plug stimulation, one compared artificial bowel sphincter with best supportive care; numbers were small in both trials. The artifical bowel sphincter insertion was followed by significant improvements in at least one primary outcome but with high rates of significant morbidity. The other trial showed no difference in primary outcome measures.
Seven studies compared different surgical interventions. These included anterior levatorplasty versus postanal repair, anterior levatorplasty versus total pelvic floor repair, total pelvic floor versus postanal repair, end to end versus overlap sphincter repair, overlap repair with or without a defunctioning stoma or with or without biofeedback, total pelvic floor repair versus repair plus internal sphincter plication and neosphincter formation versus total pelvic floor repair. Only one comparison had more than one trial (total pelvic floor versus postanal repair, n=44) and no trial showed any difference in primary outcome measures.
Comment: The quality of evidence is downgraded by limitations in study quality, by imprecise results (few patients and wide confidence intervals) and by inconsistency (heterogeneity in interventions and outcomes).
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