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Overlapping compared with end-to-end repair of complete third-degree or fourth-degree obstetric tears: three-year
Scott A Farrell1, Gordon Flowerdew, Donna Gilmour
1Department of Obstetrics and Gynaecology, Dalhousie University Halifax, Halifax, Nova Scotia, Canada. scott.farrell@iwk.nshealth.ca
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.
Conclusion:
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.
Clinical Trial Registration:
ISRCTN Register, http://isrctn.org, ISRCTNO 4149919.
Level Of Evidence:
I.
