Outcomes of primary anal sphincter repair after obstetric injury and evaluation of a novel three-choice assessment

Abstract

BackgroundThe aim of the present study was to evaluate the subjective outcome of primary repair of obstetric anal sphincter injury (OASIS) at 6 months, the factors associated with the symptoms of anal incontinence (AI), and the role of a simple survey consisting in one question with three answer choices, combined with the Wexner incontinence score for the assessment of this patient population.MethodsA retrospective cohort study was conducted on patients with third- or fourth-degree OASIS operated on between January 2007 and December 2013 inclusive at Tampere University Hospital, Finland. At 6 months, the patients were asked to report their Wexner’s score as well as the three-choice assessment regarding AI symptoms. Based on this assessment, the patients were divided into three groups: those, asymptomatic, those with mild symptoms who did not want further treatment and those with severe symptoms who were willing to undergo further evaluation and treatment.ResultsThere were 325 patients (median age 30 years). A total of 310 patients answered the questionnaire. Of which, one hundred and ninety-eight (63.9%) patients were asymptomatic, 85 (27.4%) had mild AI, and 27 (8.7%) experienced severe symptoms. There was no statistical difference in the results between the two techniques used (overlapping vs. end-to-end), or the stage of specialization of the operating physician. Persistent symptoms were associated with instrumental vaginal delivery (OR 2.12, 95% CI 1.32–3.41), severity of the injury (OR 1.64, 95% CI 1.20–2.25), and increased maternal age (OR 1.07, 95% CI 1.02–1.13). The correlation between the three-choice symptom evaluation and the Wexner score was good (Spearman’s rho 0.82).ConclusionsAfter 6 months, severe symptoms after OASIS repair were present in 9% of women and were more frequent in older women, women with high-degree tears and after instrumental vaginal delivery. A three-choice assessment of AI symptoms correlated well with the Wexner score and might be useful to triage patients who need further evaluation.

Long-term outcome of sphincteroplasty with separate suturing of the internal and the external anal sphincter

“…Our study showed a greater improvement of anal continence, with a median preoperative St. Mark’s score of 13, and a median score at long-term follow-up of 6.5. Johnson et al had a longer follow-up time, which could explain the difference, as anal incontinence is known to deteriorate with time after sphincteroplasty [18, 19, 23, 27–29]. On the other hand, it is important to note that separate suturing of the internal and the external anal sphincters was not performed in the patients in the above-mentioned study, and this could also explain why our study showed a better outcome.…”

Management of obstetric anal sphincter injury: Colorectal surgeons’ perspectives in Australia and New Zealand

“…A study which surveyed consultant members of both the Association of Coloproctology of Great Britain and Ireland and the RCOG, reported that only 10% of colorectal surgeons had a high level of experience (described as >4 repairs per year) in repairing OASIs, compared to 46.5% of the O&G cohort ( P < 0.001) 15 . A Finnish centre found that all grade four tears were repaired by O&Gs 16 . Experience is important for both detecting and repairing tears 17 .…”

Desgarros obstétricos Iatrógenos. Una entidad más frecuente de lo que desearíamos.

“…En la revisión de la Cochrane de 2013 (8) no se hallan diferencias estadísticamente significativas entre ambas técnicas en relación con el dolor perineal, la dispareunia, incontienencia para aires ni incontinencia fecal, sin embargo si se observa una reducción estadísticamente significativa de la Urgencia defecatoria en la esfinteroplastia. Por otra parte, el estudio de Kuismanen et al (9) en el que comparan ambas técnicas no encuentran diferencias estadísticamente significativas, aunque indican que los desgarros más leves se repararon con esfinterorrafia y los más graves con esfinteroplastia. Por desgracia, la mayor parte de los estudios son series cortas y retrospectivas, en las que la experiencia personal del cirujano y la escuela marcan la manera de hacerlo, siendo muy difícil de demostrar la superioridad de una u otra técnica.…”