A modified surgical approach to women with obstetric anal sphincter tears by separate suturing of external and internal anal sphincter. A modified approach to obstetric anal sphincter injury
نویسندگان
چکیده
BACKGROUND Long-term results after obstetric anal sphincter injury (OASI) are poor. We aimed to improve the long-term outcome after OASI by lessening symptoms of anal incontinence. METHODS In a prospective study at Malmö University Hospital, twenty-six women with at least grade 3B OASI were classified and sutured in a systematic way, including separate suturing of the internal and external sphincter muscles with monofilament absorbable sutures. The principal outcome assessed by answers given to six questions, was a difference in anal incontinence score, between the study group and two control groups (women with prior OASI [n = 180] and primiparous women delivered vaginally without a diagnose of OASI [n = 100]). RESULTS An anal incontinence score of zero (i.e., no symptoms) was found in 74% of the study group, 47% of the OASI control group, and 66% of the vaginal control group (p = 0.02 and 0.5, as compared to the study group). CONCLUSIONS A modified suturing technique was followed by significant improved one-year symptoms of anal incontinence as compared to historical cases.
منابع مشابه
Risk factors for and management of obstetric anal sphincter injury
Obstetric anal sphincter injury is the leading cause of faecal incontinence in women. Concerns have been expressed that some sphincter injuries are missed at the time of vaginal childbirth. There has also been a steady increase in the number of medico-legal cases associated with obstetric sphincter injury. Accurate diagnosis of third and fourth degree tears at the time of childbirth followed by...
متن کاملObstetric anal sphincter injury: how to avoid, how to repair: a literature review.
Avoiding obstetrical injury to the anal sphincter is the single biggest factor in preventing anal incontinence among women. Any form of instrument delivery has consistently been noted to increase the risk of obstetric anal sphincter injury and altered fecal continence by between 2- and 7-fold. Routine episiotomy is not recommended. Episiotomy use should be restricted to situations where it dire...
متن کاملRecurrent obstetric anal sphincter injury and the risk of long-term anal incontinence.
BACKGROUND Women with an obstetric anal sphincter injury are concerned about the risk of recurrent obstetric anal sphincter injury in their second pregnancy. Existing studies have failed to clarify whether the recurrence of obstetric anal sphincter injury affects the risk of anal and fecal incontinence at long-term follow-up. OBJECTIVE The objective of the study was to evaluate whether recurr...
متن کاملOverlapping compared with end-to-end repair of third and fourth degree obstetric anal sphincter tears.
PURPOSE OF REVIEW There is a significant risk of anal incontinence in women who sustain a third or fourth degree tear of the external anal sphincter (EAS) at the time of delivery. Optimizing the surgical correction of these injuries should result in the best functional outcome for women. The purpose of this review is to examine recent evidence. RECENT FINDINGS The results of randomized trials...
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عنوان ژورنال:
دوره 10 شماره
صفحات -
تاریخ انتشار 2010