Repair techniques for obstetric anal sphincter injuries: a randomized controlled trial.

Area of Science:

• Obstetrics and Gynecology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Obstetric anal sphincter injuries (OASIS) can lead to long-term fecal incontinence and reduced quality of life.
• Surgical repair techniques aim to restore sphincter integrity and function.
• The optimal surgical approach for primary repair remains a subject of investigation.

Purpose of the Study:

• To compare the one-year outcomes of primary overlap versus end-to-end repair of the external anal sphincter following acute OASIS.
• To evaluate the impact of repair technique on fecal incontinence, urgency, pain, and quality of life.

Main Methods:

• A randomized controlled trial involving women with third or fourth-degree perineal tears.
• Participants were allocated to either immediate primary overlap or end-to-end external anal sphincter repair.
• Prospective follow-up for 12 months included serial questionnaires assessing anal incontinence symptoms and quality of life.

Main Results:

• At 12 months, fecal incontinence was reported by 24% in the end-to-end group versus 0% in the overlap group (P = .009).
• Fecal urgency was significantly lower in the overlap group (3.7%) compared to the end-to-end group (32%) (P = .02).
• Perineal pain and deterioration of defecatory symptoms were also significantly reduced with overlap repair.

Conclusions:

• Primary overlap repair of the external anal sphincter is associated with superior one-year outcomes compared to end-to-end repair in women with OASIS.
• Overlap repair demonstrates a significantly lower incidence of fecal incontinence, urgency, and perineal pain.
• Surgical technique impacts long-term functional recovery and symptom resolution after OASIS repair.