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Delayed external sphincter repair for obstetric tear
S Laurberg1, M Swash, M M Henry
1Sir Alan Parks Physiology Unit, St. Mark's Hospital, London, UK.
Insights
Surgical repair of obstetric anal sphincter tears is less successful when patients have nerve damage. Pre-operative physiological testing can predict surgical outcomes for fecal incontinence treatment.
Area of Science:
- Obstetrics and Gynecology
- Colorectal Surgery
- Neuroscience
Background:
- Obstetric tears can cause anal sphincter weakness and fecal incontinence.
- Nerve damage (neuropathy) to the anal sphincter muscles can occur during delivery.
- Delayed surgical repair is sometimes required for these injuries.
Purpose of the Study:
- To investigate the impact of pudendal nerve damage on the success of delayed surgical repair for obstetric anal sphincter tears.
- To determine if pre-operative physiological evaluation can predict surgical outcomes.
Main Methods:
- Retrospective analysis of 19 patients undergoing delayed surgical repair for obstetric sphincter tears.
- Pre-operative anorectal physiological investigations to assess for pudendal nerve damage.
- Evaluation of surgical outcomes (excellent or good results).
Main Results:
- 47% of patients showed evidence of pudendal nerve damage pre-operatively.
- Surgical repair success was significantly higher in patients without nerve damage (80%) compared to those with nerve damage (11%).
- Pudendal nerve damage was a significant predictor of poor surgical outcomes (P = 0.018).
Conclusions:
- The functional outcome of delayed anal sphincter repair is influenced by the integrity of the nerve supply.
- Pre-operative physiological evaluation is crucial for predicting the likelihood of successful surgical intervention in these cases.
Abstract:
In some patients with faecal incontinence due to an obstetric tear of the external and sphincter there is additional weakness of the anal sphincter muscles from damage to the innervation of these muscles during delivery. Of 19 patients who required surgical repair of an obstetric sphincter tear some months or years after injury, 9 (47 per cent) had evidence of pudendal nerve damage at pre-operative anorectal physiological investigation. The result of surgical repair was excellent or good in eight of the ten patients in whom there was no evidence of nerve damage, while this was the case in only one of the nine patients with nerve damage. These results are significantly different (P = 0.018). Thus the functional result of delayed anal sphincter repair after obstetric lesions is partly dependent upon whether the nerve supply is intact. Pre-operative physiological evaluation can give information on the probability of a successful surgical result.