Abstract
BACKGROUND: This study aimed to compare the long-term continence outcomes of patients who underwent surgical repair for obstetric anal sphincter injuries (OASIS) and non-OASIS, based on the Jorge Wexner score. Additionally, predictive factors associated with complete continence restoration versus persistent fecal incontinence were analyzed. METHODS: A retrospective analysis was conducted on 13 patients treated surgically for anal sphincter injuries at Erciyes University Faculty of Medicine between 2016 and 2019, with a minimum follow-up duration of five years. Patients were categorized into obstetric (n=8) and non-obstetric (n=5) groups. Functional outcomes were assessed using the Jorge Wexner score at 6 months, 1 year, and 5 years postoperatively. Continuous variables were analyzed using the Mann-Whitney U test, categorical variables with Fisher's exact test, longitudinal changes with the Friedman test, and potential predictors of full continence were assessed via binary logistic regression. RESULTS: The non-OASIS group exhibited significantly higher mean age (p=0.045) and longer hospital stays (p=0.006) compared to the obstetric group. Perineal examination revealed more extensive tissue loss and contamination in non-OASIS cases, often requiring fecal diversion, whereas obstetric injuries were typically cleaner and linear in nature. Although higher Wexner scores were observed in the non-OASIS group at all time points, between-group differences were not statistically significant. Wexner scores varied significantly over time within the non-OASIS group (p=0.014) but not within the obstetric group (p=0.257). No individual factor showed a significant association with complete continence restoration. The logistic regression model was statistically significant overall (p=0.027), though none of the independent predictors reached significance. CONCLUSION: Compared with obstetric injuries, non-OASIS cases tend to involve a more prolonged recovery course and longer hospitalization. These findings suggest a more complex clinical trajectory in non-OASIS patients.