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Outcome of primary repair of obstetric anal sphincter rupture using the overlap technique
Pontus Molander1, Tapio Väyrynen, Jorma Paavonen
1Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland. pontus.molander@hus.fi
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.
Conclusion:
The results show that the primary overlap technique in the repair of anal sphincter rupture following vaginal delivery is highly successful.
