title: A modified surgical approach to women with obstetric anal sphincter tears by separate suturing of external and internal anal sphincter. A modified approach to obstetric anal sphincter injury.
abstract: BACKGROUND
  Long-term results after obstetric anal sphincter injury (OASI) are poor. We aimed to improve the long-term outcome after OASI by lessening symptoms of anal incontinence.
  
  
  METHODS
  In a prospective study at Malmö University Hospital, twenty-six women with at least grade 3B OASI were classified and sutured in a systematic way, including separate suturing of the internal and external sphincter muscles with monofilament absorbable sutures. The principal outcome assessed by answers given to six questions, was a difference in anal incontinence score, between the study group and two control groups (women with prior OASI [n = 180] and primiparous women delivered vaginally without a diagnose of OASI [n = 100]).
  
  
  RESULTS
  An anal incontinence score of zero (i.e., no symptoms) was found in 74% of the study group, 47% of the OASI control group, and 66% of the vaginal control group (p = 0.02 and 0.5, as compared to the study group).
  
  
  CONCLUSIONS
  A modified suturing technique was followed by significant improved one-year symptoms of anal incontinence as compared to historical cases.
authors.affiliation: Departments of Obstetrics and Gynecology, Clintech, Karolinska University Hospital, Huddinge, 14186 Huddinge, Sweden. pelle.lindqvist@ki.se
authors.forename: Pelle G
authors.initials: PG
authors.lastname: Lindqvist
authors.forename: Mats
authors.initials: M
authors.lastname: Jernetz
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000601:surgery*; D016009:Chi-Square Distribution; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D009092:Mucous Membrane / Q000601:surgery; D013513:Obstetric Surgical Procedures / Q000379:methods*; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013536:Suture Techniques; D055815:Young Adult