title: Overlapping compared with end-to-end repair of complete third-degree or fourth-degree obstetric tears: three-year follow-up of a randomized controlled trial.
abstract: OBJECTIVE
  To report on a 3-year follow-up of women who underwent overlapping repair of a complete third-degree or fourth-degree obstetric tear.
  
  
  METHODS
  Primiparous women sustaining a complete third-degree or a fourth-degree tear of the perineum were randomized to a primary sphincter repair using either an end-to-end or an overlapping surgical technique. At 1, 2, and 3 years, questionnaires on rates of flatal and fecal incontinence were mailed to participants.
  
  
  RESULTS
  At 1 year, women who underwent an end-to-end repair reported lower rates of flatal and fecal incontinence than women who had an overlapping repair. For flatal incontinence the rates were 31% compared with 56% (95% confidence interval for the rate difference 6-43%, P=.012). For fecal incontinence, the rates were 7% compared with 16% (95% confidence interval for the rate difference -4% to 21%, P=.17). The difference between the two methods of surgical repair had largely disappeared by the end of year 2.
  
  
  CONCLUSIONS
  At 1-year follow-up, end-to-end repair of complete third-degree or fourth-degree obstetric anal sphincter tears is associated with significantly lower rates of anal incontinence when compared with overlapping repair. There is no long-term benefit associated with either technique over the other.
  
  
  BACKGROUND
  ISRCTN Register, http://isrctn.org, ISRCTNO 4149919.
  
  
  METHODS
  I.
authors.affiliation: Department of Obstetrics and Gynaecology, Dalhousie University Halifax, Halifax, Nova Scotia, Canada. scott.farrell@iwk.nshealth.ca
authors.forename: Scott A
authors.initials: SA
authors.lastname: Farrell
authors.forename: Gordon
authors.initials: G
authors.lastname: Flowerdew
authors.forename: Donna
authors.initials: D
authors.lastname: Gilmour
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Turnbull
authors.forename: Matthias H
authors.initials: MH
authors.lastname: Schmidt
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Baskett
authors.forename: Cora A
authors.initials: CA
authors.lastname: Fanning
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000601:surgery; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000601:surgery*; D010502:Perineum / Q000293:injuries / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D016896:Treatment Outcome