Immediate repair of obstetric anal sphincter rupture: medium-term outcome of the overlap technique.
OBJECTIVE
Overlap sphincteroplasty is gaining popularity in the primary repair of obstetric sphincter ruptures. This study was designed to evaluate the medium-term outcome of the overlap technique.


METHODS
Between August 1997 and October 2001, 31 consecutive females who were diagnosed with a complete third-degree or fourth-degree anal sphincter rupture underwent overlap sphincteroplasty immediately after delivery. Thirty of the females were followed-up for a median of 24 months. The outcome was assessed by clinical examination, anal endosonography, Wexner score, and pelvic floor electromyography.


RESULTS
Median 24 (range, 12-63) months after delivery, 23 females (77 percent) were free of symptoms of anal incontinence. Occasional incontinence to flatus and liquid stool occurred in 17 and 7 percent of patients, respectively. Seven percent of patients had a Wexner incontinence score of > 9. The maximum mean resting pressure was 55 (range, 20-90) mmHg, and the maximum mean incremental squeeze pressure was 37 (range, 14-95) mmHg. On anal endosonography, an unrecognized internal sphincter rupture was found in one and a failed repair in two females. Overlap of the external sphincter was demonstrated in 29 patients (97 percent). One female with anal incontinence and persisting external sphincter rupture underwent redo sphincteroplasty.


CONCLUSIONS
The median-term outcome of primary overlap repair for obstetric sphincter rupture is good; however, larger, randomized studies with a longer follow-up are needed to evaluate the advantage of this technique over the end-to-end technique.
Pelvic Floor Research & Therapy Unit, Department of Gastroenterological Surgery, Central Hospital of Jyväskylä, Jyväskylä, Finland. matti.kairaluoma@ksshp.fi
Matti V
MV
Kairaluoma
Pirkko
P
Raivio
Markku T
MT
Aarnio
Ilmo H
IH
Kellokumpu
D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000601:surgery*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004576:Electromyography; D005242:Fecal Incontinence / Q000145:classification / Q000209:etiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D012421:Rupture; D012720:Severity of Illness Index; D013536:Suture Techniques; D016896:Treatment Outcome