title: Long-term outcome of delayed primary or early secondary reconstruction of the anal sphincter after obstetrical injury.
abstract: OBJECTIVE
  Traditionally sphincter repair has not been performed during the puerperium. This prospective study was designed to determine the long-term outcome of delayed primary or early secondary sphincteroplasty in the puerperium.
  
  
  METHODS
  Between 1991 and 2005, 22 females underwent delayed primary or early secondary repair after third-degree or fourth-degree anal sphincter rupture. Delayed primary reconstruction was performed more than 72 hours after delivery. Early secondary reconstruction was performed within 14 days postpartum. The reconstruction of the anal sphincter was performed without a covering stoma, in all cases. A control group of 19 age-matched and parity-matched females, without known anal sphincter injury after vaginal delivery, were included. Current degree of continence and associated quality of life were determined by a fecal incontinence severity questionnaire and a quality of life questionnaire.
  
  
  RESULTS
  None of the females had complications postoperatively. Mean follow-up was 50 (range, 2-155) months in the case group and 60 (range, 12-132) months in the control group. At time of follow-up, the Wexner score was 4.1 (range, 0-13) in females with delayed primary or early secondary reconstruction and 1.1 (range, 0-8) in the control group (P<0.01). The inconvenience of incontinence after reconstruction was significantly higher (P<0.01) compared with the control group, but the quality of life was not significantly affected (P=0.75).
  
  
  CONCLUSIONS
  It is safe to perform a delayed primary or early secondary reconstruction without a covering stoma in females who have sustained a third-degree or fourth-degree obstetric tear. The long-term functional outcome is acceptable.
authors.affiliation: Surgical Research Unit Department of Surgery P, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000, Aarhus, Denmark. soerensen_mette@dadlnet.dk
authors.forename: Mette M
authors.initials: MM
authors.lastname: Soerensen
authors.forename: Karl M
authors.initials: KM
authors.lastname: Bek
authors.forename: Steen
authors.initials: S
authors.lastname: Buntzen
authors.forename: Karen-Elise
authors.initials: KE
authors.lastname: Højberg
authors.forename: Søren
authors.initials: S
authors.lastname: Laurberg
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000601:surgery*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D022125:Lacerations / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012307:Risk Factors; D012421:Rupture / Q000209:etiology / Q000601:surgery; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome