How to repair an anal sphincter injury after vaginal delivery: results of a randomised controlled trial.
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.
Williams
Abimbola
A
Department of Urogynaecology, Liverpool Womens' Hospital, and Reproductive Science Section, CSMM, University of Leicester, UK.
Adams
Elisabeth J
EJ
Tincello
Douglas G
DG
Alfirevic
Zarko
Z
Walkinshaw
Stephen A
SA
Richmond
David H
DH
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
D016687:Polydioxanone; D011098:Polyglactin 910