Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques.
OBJECTIVE
This study was undertaken to compare surgical techniques for the primary repair of obstetric anal sphincter lacerations.


METHODS
Patients with complete third- or fourth-degree lacerations were recruited and randomly assigned to either an end-to-end or overlapping repair. Data collection included demographic data, obstetric history, and intrapartum events. Postpartum, women completed incontinence questionnaires and underwent physical and ultrasound examinations. To detect a 36% difference between groups with an alpha = .05 and beta = .20, 30 patients were required. Data were analyzed with Student t test and chi2 analysis.


RESULTS
Forty-one women were randomly assigned; 23 to an end-to-end and 18 to an overlapping repair. Twenty-seven percent of women underwent episiotomy and 61% operative vaginal delivery. Follow-up was limited to 26 of 41 patients. On physical examination, 3 patients had a separated anal sphincter. On ultrasound, overall 85% of patients had intact sphincters, with no difference between groups (all P > .05). Forty-two percent of women complained of anorectal symptoms with no differences between groups (all P > .28).


CONCLUSIONS
We found no difference in anal incontinence symptoms, physical examination, or translabial ultrasonography findings between the 2 groups. Incontinence symptoms were common in both groups.
Garcia
Victoria
V
University of New Mexico Health Sciences Center, Albuquerque, USA.
Rogers
Rebecca G
RG
Kim
Suzy S
SS
Hall
Rebecca J
RJ
Kammerer-Doak
Dorothy N
DN
D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D001004:Anus Diseases / Q000209:etiology; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D004841:Episiotomy; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D022125:Lacerations / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D013513:Obstetric Surgical Procedures / Q000379:methods*; D011247:Pregnancy; D012002:Rectal Diseases / Q000209:etiology; D014463:Ultrasonography