Overlap Technique Improves Results of Primary Surgery after Obstetric Anal Sphincter Tear

Lepistö, Anna; Pinta, Tarja; Kylänpää, Marja-Leena; Halmesmäki, Erja; Väyrynen, Tapio; Sariola, A.; Stefanović, Vedran; Aitokallio-Tallberg, Ansa; Ulander, Veli-Matti; Molander, Pontus; Luukkonen, Pekka

doi:10.1007/s10350-007-9182-3

Cited by 8 publications

(3 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some surgeons have improved the complex injury of anal sphincter repair by including inner anal sphincter repair and outer anal sphincter repair [9]. In cases with external anal sphincter tears, the risk of fecal incontinence caused by overlapping suture is lower [10]. The overlap technique requires more dissection and mobilization of the sphincter ends, along the ischioannal fossa [11].…”

Section: Discussionmentioning

confidence: 99%

Transperineal Sphincter Repair Combined with Perineal Body Reconstruction in the Treatment of Old Fourth-Degree Perineal Tears: A Preliminary Experience

Qin¹,

Li²

2022

Clin. Exp. Obstet. Gynecol.

View full text Add to dashboard Cite

Background: To investigate the clinical effect of sphincter repair combined with perineal body reconstruction in the treatment of old fourth-degree perineal tears. Method: A prospective database of five patients with old fourth-degree perineal tears treated between January 2015 and January 2021 was established and studied retrospectively. Results: All five patients were followed-up with for 1 year, and anal incontinence was cured. The anal function recovered, and the anal shape was satisfactory. Three months after the operation, transperineal ultrasonography showed continuity of the anal sphincter, anal mucosa, and perianal skin. Anorectal manometry was performed 3 months after the operation. The anal resting pressure (56.20 ± 3.42 mmHg), the maximum anal systolic pressure (90.00 ± 5.39 mmHg), and the maximum anal systolic time (20.80 ± 3.77 s) were significantly higher than the preoperative anal resting pressure (11.80 ± 1.79 mmHg), maximum anal systolic pressure (31.40 ± 3.21 mmHg), and maximum anal systolic time (8.40 ± 1.52 s), respectively (t = -25.720, p < 0.01; t = -20.902, p < 0.01; t = -6.826, p < 0.01). The Wexner scores at 3, 6, and 12 months after the operation were (1.00 ± 0.71), (0.40 ± 0.55), and (0.20 ± 0.45), respectively, which were significantly lower than the preoperative Wexner score (15.00 ± 1.00) (t = 25.560, p < 0.01; t = 28.633, p < 0.01; t = 30.210, p < 0.01). Conclusions: Transperineal sphincter repair combined with perineal body reconstruction is safe and effective in the treatment of old fourth-degree perineal tears. The initial results are encouraging, indicating the need for a more formal evaluation of the technology.

show abstract

Section: Discussionmentioning

confidence: 99%

Transperineal Sphincter Repair Combined with Perineal Body Reconstruction in the Treatment of Old Fourth-Degree Perineal Tears: A Preliminary Experience

Qin¹,

Li²

2022

Clin. Exp. Obstet. Gynecol.

View full text Add to dashboard Cite

show abstract

“…Several papers have compared overlap with end-to-end technique in OASI [5,16-18]; three of the studies were randomised [5,17,18]. One study also compares the overlap technique with historical controls [19].…”

Section: Discussionmentioning

confidence: 99%

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

Lindqvist

Jernetz

2010

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

BackgroundLong-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.MethodsIn 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]).ResultsAn 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).ConclusionsA modified suturing technique was followed by significant improved one-year symptoms of anal incontinence as compared to historical cases.

show abstract

“…In most cases, primary repair results in adequate continence. The recommended method of primary sphincter repair is overlapping sphincteroplasty (5)(6)(7). In cases where overlapping of the muscle fibers cannot be achieved, end-to-end suturing is also acceptable (8).…”

Section: Introductionmentioning

confidence: 99%

3T external phased-array magnetic resonance imaging in detection of obstetric anal sphincter lesions: a pilot study

et al. 2022

View full text Add to dashboard Cite

Background Three-dimensional endoanal ultrasound (3D EAUS) has been the gold standard for detecting anal sphincter lesions in patients with a history of obstetric anal sphincter injury (OASI). Advances in imaging technologies have facilitated the detection of these lesions with external phased-array magnetic resonance imaging (MRI), which could offer an alternative imaging modality for the diagnosis of residual OASI (ROASI) in centers where 3D EAUS imaging is not available. Purpose To compare two diagnostic modalities: the 3D EAUS and 3T external phased-array MRI in the detection of residual anal sphincter lesions. Material and Methods A total of 24 women with a history of OASI were imaged with both 3D EAUS and 3T external phased-array MRI after primary repair of the injury. Intraclass correlation (ICC) and interrater reliability (IRR) values were calculated for the grade and circumference of the sphincter lesion. Sphincter lesions were graded according to the Sultan classification. Results There was an almost perfect agreement between 3D EAUS and 3T external phased-array MRI in determining the extent of the sphincter lesions according to the Sultan classification (κ = 0.881; P < 0.001) and the circumference of the external anal sphincter defects, measured in degrees (κ = 0.896; P < 0.001). Conclusion The results of this study indicate that 3T external phased-array MRI and 3D EAUS yield comparable results in the diagnosis of ROASI. These findings suggest that 3T external phased-array MRI could serve as an alternative diagnostic modality to 3D EAUS in the diagnosis of ROASI.

show abstract

Overlap Technique Improves Results of Primary Surgery after Obstetric Anal Sphincter Tear

Abstract: The overlap technique should be adopted as the method of choice for primary sphincter repair after obstetric tear.

Cited by 8 publications

References 48 publications

Transperineal Sphincter Repair Combined with Perineal Body Reconstruction in the Treatment of Old Fourth-Degree Perineal Tears: A Preliminary Experience

Transperineal Sphincter Repair Combined with Perineal Body Reconstruction in the Treatment of Old Fourth-Degree Perineal Tears: A Preliminary Experience

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

3T external phased-array magnetic resonance imaging in detection of obstetric anal sphincter lesions: a pilot study

Contact Info

Product

Resources

About