Sphincter lesions observed on ultrasound after transanal endoscopic surgery

Table 1 Modified Starck classification

Score	0	1	2	3
Eas defect
Length	No	≤ 50%	> 50%	Total
Depth	No	Partial	Total	-
Size	No	≤ 90°	90°-180°	>180°
EAS fragmentation : Yes/no
IAS defect
Length	No	≤ 50%	> 50%	Total
Depth	No	Partial	Total	-
Size	No	≤ 90°	90°-180°	> 180°
IAS fragmentation: Yes /no
No defect: Score = 0; Maximum defect: Score =16
Considered as defect: score > 8

EAS: External anal sphincter; IAS: Internal anal sphincter.

Table 2 Patient characteristics

Lesion characteristics
Lesion size	4.3 ± 2.17 cm	(1-12 cm)
Lesion height	10.2 ± 14.02 cm	(1-15 cm)
Quadrants affected by lesion	1 quadrant: 40 patients
	2 quadrants: 52 patients
	3 quadrants: 10 patients
	4 quadrants: 1 patient
Surgical characteristics
Surgical time	98.0 ± 45.4 min	(25-265 min)
Surgical position	Lithotomy: 29 patients
	Prone: 24 patients
	Left lateral: 29 patients
	Right lateral: 21 patients
Hospital stay	4.2 ± 3.38 d	(2-34 d)

Table 3 Description of ultrasound lesions applying the Starck classification

Case	One month post-op (31/106 - 29.2%)						STARCK	Four months post-op (7/106 - 6.6%)						STARCK
	Length		Depth		Size			Length		Depth		Size
	IAS (10/31) - Median Starck score: 4							IAS (7) - Median Starck score: 4
1	Medium anal canal	1	Complete	2	70°	1	4	Medium anal canal	2	Complete	2	70°	1	4
2	Medium anal canal	1	Partial	1	45°	2	3	Medium anal canal	1	Partial	1	45°	2	3
3	Medium anal canal	1	Complete	2	110°	1	5	Medium anal canal	1	Complete	2	110°	1	5
4	Medium anal canal	1	Partial	1	65°	1	3	Medium anal canal	1	Complete	2	180°	2	5
5	Medium and upper anal canal	2	Partial	1	141°	2	5	Medium and upper anal canal	2	Partial	1	141°	1	5
6	Medium and upper anal canal	2	Complete	2	95°	1	5	Medium and upper anal canal	2	Complete	2	95°	2	6
7	Medium anal canal	1	Partial	1	65°	1	5	Medium anal canal	1	Partial	1	65°	1	3
8	Medium anal canal	1	Partial	1	125°	2	4
9	Medium anal canal	1	Partial	1	63°	2	3
10	Upper anal canal	1	Partial	1	27°	1	3
	EAS (3/31) - Median Starck score 4							EAS
1	Medium anal canal	1	Complete	2	55°	1	4
2	Lower and medium anal canal	2	Complete	2	105°	1	6
3	Medium anal canal	1	Complete	2	60°	1	4
	Sphincter fragmentation							Sphincter fragmentation
	IAS: 17						0
	EAS: 1 (Accompanied by IAS fragmentation)						0

EAS: External anal sphincter; IAS: Internal anal sphincter.

Table 4 Description of sphincter width

	EAI			EAE			WEXNER
	Average difference	DE	P value	Average difference	DE	P value	McNemar (Sig)
Preop-1m	-0.70	1.58	0.0008	-0.310	2.34	0.13	1.0
Preop- 4m	-0.38	1.81	0.0590	0.081	2.51	0.59	0.4