Outcome of primary repair of obstetric anal sphincter rupture using the overlap technique.
BACKGROUND
Grade III and IV anal sphincter ruptures after vaginal delivery are an increasing problem. We assessed the outcome of an overlap technique in primary repair.


METHODS
In this retrospective observational study, from 2002 to 2004, 61 consecutive women with grade III and IV obstetric tears were included. Of the 61 women, 42 had complete rupture of the external sphincter and underwent sphincter repair using standardised overlap technique. The outcome was assessed by clinical examination, Wexner questionnaire, and endoanal ultrasonography (EAUS), after a median follow-up of 9.4 months. Main outcome measure was continence following primary repair.


RESULTS
At follow-up, 64% of the patients had no symptoms of anal incontinence. A total of 29% experienced occasional incontinence to flatus, 1 patient (2%) experienced occasional incontinence to liquid stools, and 1 patient to liquid or normal stools. EAUS revealed intact external sphincter in 29 of the 35 patients (83%). In 6 patients (17%), EAUS showed partial discontinuity of the sphincter muscle.


CONCLUSIONS
The results show that the primary overlap technique in the repair of anal sphincter rupture following vaginal delivery is highly successful.
Molander
Pontus
P
Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland. pontus.molander@hus.fi
Väyrynen
Tapio
T
Paavonen
Jorma
J
Lepistö
Anna
A
Luukkonen
Pekka
P
D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000601:surgery*; D004841:Episiotomy / Q000009:adverse effects; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012421:Rupture / Q000601:surgery; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects