title: How to repair an anal sphincter injury after vaginal delivery: results of a randomised controlled trial.
abstract: OBJECTIVE
  To compare two surgical techniques and two types of suture material for anal sphincter repair after childbirth-related injury.
  
  
  METHODS
  Factorial randomised controlled trial.
  
  
  METHODS
  Tertiary referral maternity unit.
  
  
  METHODS
  Women with an anal sphincter injury sustained during childbirth.
  
  
  METHODS
  Women were randomised into four groups: overlap repair with polyglactin (Vicryl); end-to-end repair with polyglactin (Vicryl); overlap repair with polydioxanone (PDS); and end-to-end repair with PDS. All repairs were completed as a primary procedure by staff trained in both methods.
  
  
  METHODS
  Suture-related morbidity at six weeks. Bowel symptoms at 3, 6 and 12 months. Anorectal physiology at three months. Quality of life scores at 3 and 12 months.
  
  
  RESULTS
  One hundred and fifty women (1.5% of deliveries) were eligible and 112 (75%) were randomised. One hundred and three (92%) attended follow up visit at 6 weeks, 89 (80%) at 3 months, 79 (71%) at 6 months and 60 (54%) at 12 months. At six weeks, there was no difference in suture-related morbidity between groups (P=0.11) and 70% patients were completely asymptomatic. Incidence of bowel symptoms and quality of life disturbances were low, with no differences between the four groups.
  
  
  CONCLUSIONS
  Obstetric anal sphincter repair carried out by appropriately trained staff is associated with low morbidity, irrespective of the suture material and repair method used.
authors.affiliation: Department of Urogynaecology, Liverpool Womens' Hospital, and Reproductive Science Section, CSMM, University of Leicester, UK.
authors.forename: Abimbola
authors.initials: A
authors.lastname: Williams
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Adams
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Tincello
authors.forename: Zarko
authors.initials: Z
authors.lastname: Alfirevic
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Walkinshaw
authors.forename: David H
authors.initials: DH
authors.lastname: Richmond
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D019160:Endosonography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016687:Polydioxanone / Q000009:adverse effects*; D011098:Polyglactin 910 / Q000009:adverse effects*; D011247:Pregnancy; D011446:Prospective Studies; D013536:Suture Techniques / Q000009:adverse effects; D013537:Sutures / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D016687:Polydioxanone; D011098:Polyglactin 910