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Primary repair of advanced obstetric anal sphincter tears: should it be performed by the overlapping sphincteroplasty technique?

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Abstract

Advanced obstetric anal sphincter tears are often associated with a high incidence of fecal and flatus incontinence. We aimed to assess the clinical outcome of these repairs when done by the overlapping sphincteroplasty technique with reconstruction of the internal anal sphincter and perineum. Between August 2005 and December 2006, all grades 3 and 4 obstetric anal sphincter tears in our department were repaired by a reconstructive pelvic surgeon, primarily using the overlapping sphincteroplasty technique with reconstruction of the internal anal sphincter and perineum. All women were followed every 6 months using the Colorectal Anal Distress Inventory and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, a physical examination of the anal sphincter, anal manometry, and transperineal anal sonography. There were 3,478 deliveries of which 22 (0.63%) anal sphincter tears were repaired in women aged 22–41 years. Two women were diagnosed with Royal College of Obstetricians and Gynecologists grade 3a, eight with grade 3b, nine with grade 3c, and three with grade 4 anal sphincter tears. Postoperatively, 21 patients attended the outpatient clinic, with an average follow-up time of 9.2 ± 1.4 months. Only two women (9.5%) complained of flatus incontinence and fecal urgency and had mildly decreased anal sphincter squeeze pressure and a small sonographic anal sphincter defect. None of the women complained of fecal incontinence. Two women (9.5%) reported on transient perineal pain and one (4.8%) on transient dyspareunia. All other women were asymptomatic and had normal anal manometry and sonographic evaluation. Repair of obstetric anal sphincter tears using the overlapping sphincteroplasty technique with reconstruction of the internal anal sphincter and perineum seems to carry favorable clinical outcome and reduced risk for anal incontinence, perineal pain, and sexual dysfunction.

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References

  1. Sultan AH, Kamm MA, Hudson CN, Bartram CI (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 1994; 308:887–891

    CAS  Google Scholar 

  2. Haadem K, Dahlstrom JA, Ling L, Ohrlander S (1987) Anal sphincter function after delivery rupture. Obstet Gynecol 70:53–56

    PubMed  CAS  Google Scholar 

  3. Haadem K, Ohrlander S, Lingman G (1988) Long term ailments due to anal sphincter rupture caused by delivery: a hidden problem. Eur J Obstet Gynecol Reprod Biol 27:27–32

    Article  PubMed  CAS  Google Scholar 

  4. Nazir M, Carlsen E, Jacobsen AF, Nesheim BI (2002) Is there any correlation between objective anal testing, rupture grade and bowel symptoms after primary repair of obstetric anal sphincter injury? Dis Colon Rectum 45:1325–1331

    Article  PubMed  Google Scholar 

  5. Fernando RJ, Sultan AH, Radley S, Jones PW, Johanson RB (2002) Management of obstetric anal sphincter injury: a systematic review and national practice survey. BMC Health Serv Res 2:9–24

    Article  PubMed  Google Scholar 

  6. Norton C, Christiansen J, Butler U, Harari D, Nelson RL, Pemberton J et al (2002) Anal incontinence. In: Abrams P, Cardozo L, Khoury Wein A (eds) Incontinence. 2nd edn. Health Publication, Plymouth, UK, pp 985–1044

    Google Scholar 

  7. Mellgren A, Jensen LL, Zetterstrom JP, Wong WD, Hofmeister JH, Lowry AC (1999) Long term cost of fecal incontinence secondary to obstetric injuries. Dis Colon Rectum 42:857–867

    Article  PubMed  CAS  Google Scholar 

  8. Sultan AH (1999) Obstetric perineal injury and anal incontinence Clin Risk 5:193–196

    Google Scholar 

  9. Sultan AH, Thakar R (2002) Lower genital tract and anal sphincter trauma. Best Pract Res Clin Obstet Gynecol 16:99–115

    Article  Google Scholar 

  10. Sultan AH, Monga AK, Kumar D, Stanton SL (1999) Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol 106:318–323

    PubMed  CAS  Google Scholar 

  11. Adams EJ, Fernando RJ (2001) Management of third and fourth degree perineal tears following vaginal delivery. Guideline No 29. London: Royal College of Obstetricians & Gynecologists

  12. Kettle C, Hills RK, Jones P, Darby L, Gray R, Johanson R (2000) Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomized controlled trial. Lancet 359:2217–2223

    Article  Google Scholar 

  13. Barber MD, Kuchibhatla MN, Pieper CF, Bump RC (2001) Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 185:1388–1395

    Article  PubMed  CAS  Google Scholar 

  14. Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C (2003) A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunction 14:164–168

    Article  Google Scholar 

  15. Hallan RI, Marzouk DE, Waldron DJ, Womack NR, Williams NS (1989) Comparison of digital and manometric assessment of anal sphincter function. Br J Surg 76–973

  16. Felt-Bersma RJ, Gort G, Meuwissen SG (1991) Normal values in anal manometry and rectal sensation: a problem of range. Hepatogastroenterology 38:444–449

    PubMed  CAS  Google Scholar 

  17. Kleinubing H Jr, Jannini JF, Malafaia O, Brenner S, Pinho M (2000) Transperineal ultrasonography: new method to image the anorectal region. Dis Colon Rectum 43:1572–1574

    Article  PubMed  Google Scholar 

  18. Valsky DV, Messing B, Petkova R, Savchev S, Rosenak D, Hochner-Celnikier D, Yagel S (2007) Postpartum evaluation of the anal sphincter by transperineal three-dimensional ultrasound in primiparous women after vaginal delivery and following surgical repair of third-degree tears by the overlapping technique. Ultrasound Obstet Gynecol 29:195–204

    Article  PubMed  CAS  Google Scholar 

  19. Fitzpatrick M, Behan M, O’Connell PR, O’Herlihy C (2000) A randomized clinical trial comparing primary overlap with approximation repair of third degree obstetric tears. Am J Obstet Gynecol 183:1220–1224

    Article  PubMed  CAS  Google Scholar 

  20. Garcia V, Rogers RG, Kim SS, Hall RJ, Kammerer-Doak DN (2005) Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques. Am J Obstet Gynecol 192:1697–1701

    Article  PubMed  Google Scholar 

  21. Fernando RJ, Sultan AH, Kettle C, Radley S, Jones P, Obrien MS (2006) Repair techniques for obstetrics anal injury. Obstet Gynecol 107:1261–1268

    PubMed  Google Scholar 

  22. Williams A, Adams EJ, Tincello DG, Alfirevic Z, Walkinshaw SA, Richmond DH (2006) How to repair an anal sphincter injury after vaginal delivery: Results of a randomized controlled trial. BJOG 113:201–207

    Article  PubMed  Google Scholar 

  23. Cook TA, Mortenson NJMC (1998) Management of faecal incontinence following obstetric injury. Br J Surg 85:293–299

    Article  PubMed  CAS  Google Scholar 

  24. Sultan AH, Kamm MA, Hudson CN (1995) Obstetric perineal trauma: an audit of training. J Obstet Gynaecol 15:19–23

    Article  Google Scholar 

  25. Schofield PF, Grace R (1999) Faecal Incontinence after childbirth. Clinical Risk 5:201–204

    Google Scholar 

  26. Mahony R, Behan M, O’Herlihy C, O’Connell PR (2004) Randomized, clinical trial of bowel confinement vs. laxative use after primary repair of a third-degree obstetric anal sphincter tear. Dis Colon Rectum 47:12–17

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Urogynecology and Reconstructive Pelvic Surgery, Haifa, Israel

    Yoram Abramov, Beni Feiner, Thalma Rosen, Arie Lissak & Ron Auslander

  2. Division of Perinatology, Department of Obstetrics and Gynecology, Carmel Medical Center, Rappaport School of Medicine, Technion University, Haifa, Israel

    Motti Bardichev & Eli Gutterman

  3. Department of Obstetrics and Gynecology, Carmel Medical Center, 7 Michal Street, Haifa, 34362, Israel

    Yoram Abramov

Authors
  1. Yoram Abramov
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  2. Beni Feiner
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  3. Thalma Rosen
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  4. Motti Bardichev
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  5. Eli Gutterman
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  6. Arie Lissak
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  7. Ron Auslander
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Correspondence to Yoram Abramov.

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Abramov, Y., Feiner, B., Rosen, T. et al. Primary repair of advanced obstetric anal sphincter tears: should it be performed by the overlapping sphincteroplasty technique?. Int Urogynecol J 19, 1071–1074 (2008). https://doi.org/10.1007/s00192-008-0592-0

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  • DOI: https://doi.org/10.1007/s00192-008-0592-0

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