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Updated: Jul 5, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Immediate or delayed repair of obstetric anal sphincter tears-a randomised controlled trial
J Nordenstam1, A Mellgren, D Altman
1Division of Surgery, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. nord0464@umn.edu
Objective:
To investigate if an 8- to 12-hour time delay of primary repair affects anal incontinence at 1-year follow up.
Design:
Randomised controlled trial.
Setting:
University hospital in Sweden.
Population:
A total of 165 women diagnosed with a third- to fourth-degree perineal tear.
Methods:
The participants were randomised to immediate or delayed (8- to 12-hour delay) end-to-end repair; 78 were allocated to immediate operation and 87 to a delayed repair. An incontinence and pelvic floor symptom questionnaire was completed by the participants at baseline and at 6- and 12-month follow up.
Main Outcome Measures:
Anal incontinence measured by the validated Pescatori incontinence score.
Results:
A total of 161 (98%) and 155 (94%) women completed the two follow-up questionnaires. There was no significant difference in anal incontinence between the groups. There were no significant differences in pelvic floor symptoms between the groups. A multivariate proportional odds model revealed that increasing maternal age was significantly associated with both increased symptoms of faecal urgency and inability to discriminate flatus from faeces.
Conclusion:
Delayed repair provided the same functional outcome at 1-year follow up. Delaying the repair should thus not be recommended routinely, but can be an alternative under special circumstances when appropriate surgical expertise is not readily available.