Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2010

Open Access 01-12-2010 | Research article

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

Authors: Pelle G Lindqvist, Mats Jernetz

Published in: BMC Pregnancy and Childbirth | Issue 1/2010

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Pirhonen JP, Grenman SE, Haadem K, Gudmundsson S, Lindqvist P, Siihola S, Erkkola RU, Marsal K: Frequency of anal sphincter rupture at delivery in Sweden and Finland -- result of difference in manual help to the baby's head. Acta Obstet Gynecol Scand. 1998, 77: 974-977. 10.1080/j.1600-0412.1998.771005.x.CrossRefPubMed Pirhonen JP, Grenman SE, Haadem K, Gudmundsson S, Lindqvist P, Siihola S, Erkkola RU, Marsal K: Frequency of anal sphincter rupture at delivery in Sweden and Finland -- result of difference in manual help to the baby's head. Acta Obstet Gynecol Scand. 1998, 77: 974-977. 10.1080/j.1600-0412.1998.771005.x.CrossRefPubMed
2.
go back to reference Gjessing H, Backe B, Sahlin Y: Third degree obstetric tears: outcome after primary repair. Acta Obstet Gynecol Scand. 1998, 77: 736-740. 10.1080/j.1600-0412.1998.770707.x.CrossRefPubMed Gjessing H, Backe B, Sahlin Y: Third degree obstetric tears: outcome after primary repair. Acta Obstet Gynecol Scand. 1998, 77: 736-740. 10.1080/j.1600-0412.1998.770707.x.CrossRefPubMed
3.
go back to reference Haadem K, Ohrlander S, Lingman G: Long-term ailments due to anal sphincter rupture caused by delivery -- a hidden problem. Eur J Obstet Gynecol Reprod Biol. 1988, 27: 27-32. 10.1016/S0028-2243(88)80007-8.CrossRefPubMed Haadem K, Ohrlander S, Lingman G: Long-term ailments due to anal sphincter rupture caused by delivery -- a hidden problem. Eur J Obstet Gynecol Reprod Biol. 1988, 27: 27-32. 10.1016/S0028-2243(88)80007-8.CrossRefPubMed
4.
go back to reference Sultan AH, Monga AK, Kumar D, Stanton SL: Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol. 1999, 106: 318-323.CrossRefPubMed Sultan AH, Monga AK, Kumar D, Stanton SL: Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol. 1999, 106: 318-323.CrossRefPubMed
5.
go back to reference Fitzpatrick M, Behan M, O'Connell PR, O'Herlihy C: A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. Am J Obstet Gynecol. 2000, 183: 1220-1224. 10.1067/mob.2000.108880.CrossRefPubMed Fitzpatrick M, Behan M, O'Connell PR, O'Herlihy C: A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. Am J Obstet Gynecol. 2000, 183: 1220-1224. 10.1067/mob.2000.108880.CrossRefPubMed
6.
go back to reference Lestar B, Penninckx F, Kerremans R: The composition of anal basal pressure. An in vivo and in vitro study in man. Int J Colorectal Dis. 1989, 4: 118-122. 10.1007/BF01646870.CrossRefPubMed Lestar B, Penninckx F, Kerremans R: The composition of anal basal pressure. An in vivo and in vitro study in man. Int J Colorectal Dis. 1989, 4: 118-122. 10.1007/BF01646870.CrossRefPubMed
7.
go back to reference Starck M, Bohe M, Valentin L: Effect of vaginal delivery on endosonographic anal sphincter morphology. Eur J Obstet Gynecol Reprod Biol. 2007, 130: 193-201. 10.1016/j.ejogrb.2006.04.009.CrossRefPubMed Starck M, Bohe M, Valentin L: Effect of vaginal delivery on endosonographic anal sphincter morphology. Eur J Obstet Gynecol Reprod Biol. 2007, 130: 193-201. 10.1016/j.ejogrb.2006.04.009.CrossRefPubMed
8.
go back to reference Pena A, Hong A: Advances in the management of anorectal malformations. Am J Surg. 2000, 180: 370-376. 10.1016/S0002-9610(00)00491-8.CrossRefPubMed Pena A, Hong A: Advances in the management of anorectal malformations. Am J Surg. 2000, 180: 370-376. 10.1016/S0002-9610(00)00491-8.CrossRefPubMed
9.
go back to reference Cunningham F, Leveno K, Gilstrap L: Williams Obstetrics. 2006, Mcgrav-Hill Publishing CO Cunningham F, Leveno K, Gilstrap L: Williams Obstetrics. 2006, Mcgrav-Hill Publishing CO
10.
go back to reference Fornell EK, Berg G, Hallböök O, Matthiesen LS, Sjödahl R: Clinical consequences of anal sphincter rupture during vaginal delivery. J Am Coll Surg. 1996, 183: 553-558.PubMed Fornell EK, Berg G, Hallböök O, Matthiesen LS, Sjödahl R: Clinical consequences of anal sphincter rupture during vaginal delivery. J Am Coll Surg. 1996, 183: 553-558.PubMed
12.
go back to reference Fornell EU, Matthiesen L, Sjödahl R, Berg G: Obstetric anal sphincter injury ten years after: subjective and objective long term effects. BJOG. 2005, 112: 312-316. 10.1111/j.1471-0528.2004.00400.x.CrossRefPubMed Fornell EU, Matthiesen L, Sjödahl R, Berg G: Obstetric anal sphincter injury ten years after: subjective and objective long term effects. BJOG. 2005, 112: 312-316. 10.1111/j.1471-0528.2004.00400.x.CrossRefPubMed
13.
go back to reference Faltin DL, Boulvain M, Irion O, Bretones S, Stan C, Weil A: Diagnosis of anal sphincter tears by postpartum endosonography to predict fecal incontinence. Obstet Gynecol. 2000, 95: 643-647. 10.1016/S0029-7844(99)00631-6.PubMed Faltin DL, Boulvain M, Irion O, Bretones S, Stan C, Weil A: Diagnosis of anal sphincter tears by postpartum endosonography to predict fecal incontinence. Obstet Gynecol. 2000, 95: 643-647. 10.1016/S0029-7844(99)00631-6.PubMed
14.
go back to reference Sultan AH, Johanson RB, Carter JE: Occult anal sphincter trauma following randomized forceps and vacuum delivery. Int J Gynaecol Obstet. 1998, 61: 113-119. 10.1016/S0020-7292(98)00017-4.CrossRefPubMed Sultan AH, Johanson RB, Carter JE: Occult anal sphincter trauma following randomized forceps and vacuum delivery. Int J Gynaecol Obstet. 1998, 61: 113-119. 10.1016/S0020-7292(98)00017-4.CrossRefPubMed
15.
go back to reference Groom KM, Paterson-Brown S: Can we improve on the diagnosis of third degree tears?. Eur J Obstet Gynecol Reprod Biol. 2002, 101: 19-21. 10.1016/S0301-2115(01)00495-X.CrossRefPubMed Groom KM, Paterson-Brown S: Can we improve on the diagnosis of third degree tears?. Eur J Obstet Gynecol Reprod Biol. 2002, 101: 19-21. 10.1016/S0301-2115(01)00495-X.CrossRefPubMed
16.
go back to reference Lepisto A, Pinta T, Kylanpaa ML, Halmesmaki E, Vayrynen T, Sariola A, Stefanovic V, Aitokallio-Tallberg A, Ulander VM, Molander P, Luukkonen P: Overlap technique improves results of primary surgery after obstetric anal sphincter tear. Dis Colon Rectum. 2008, 51: 421-425. 10.1007/s10350-007-9182-3.CrossRefPubMed Lepisto A, Pinta T, Kylanpaa ML, Halmesmaki E, Vayrynen T, Sariola A, Stefanovic V, Aitokallio-Tallberg A, Ulander VM, Molander P, Luukkonen P: Overlap technique improves results of primary surgery after obstetric anal sphincter tear. Dis Colon Rectum. 2008, 51: 421-425. 10.1007/s10350-007-9182-3.CrossRefPubMed
17.
go back to reference Fernando RJ, Sultan AH, Kettle C, Radley S, Jones P, O'Brien PM: Repair techniques for obstetric anal sphincter injuries: a randomized controlled trial. Obstet Gynecol. 2006, 107: 1261-1268. 10.1097/01.AOG.0000218693.24144.bd.CrossRefPubMed Fernando RJ, Sultan AH, Kettle C, Radley S, Jones P, O'Brien PM: Repair techniques for obstetric anal sphincter injuries: a randomized controlled trial. Obstet Gynecol. 2006, 107: 1261-1268. 10.1097/01.AOG.0000218693.24144.bd.CrossRefPubMed
18.
go back to reference Garcia V, Rogers RG, Kim SS, Hall RJ, Kammerer-Doak DN: Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques. Am J Obstet Gynecol. 2005, 192: 1697-1701. 10.1016/j.ajog.2004.11.045.CrossRefPubMed Garcia V, Rogers RG, Kim SS, Hall RJ, Kammerer-Doak DN: Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques. Am J Obstet Gynecol. 2005, 192: 1697-1701. 10.1016/j.ajog.2004.11.045.CrossRefPubMed
19.
go back to reference Norderval S, Oian P, Revhaug A, Vonen B: Anal incontinence after obstetric sphincter tears: outcome of anatomic primary repairs. Dis Colon Rectum. 2005, 48: 1055-1061. 10.1007/s10350-004-0887-2.CrossRefPubMed Norderval S, Oian P, Revhaug A, Vonen B: Anal incontinence after obstetric sphincter tears: outcome of anatomic primary repairs. Dis Colon Rectum. 2005, 48: 1055-1061. 10.1007/s10350-004-0887-2.CrossRefPubMed
20.
go back to reference Malouf A, Norton C, Engel A, Nicholls R, Kamm M: Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet. 2000, 355: 260-265. 10.1016/S0140-6736(99)05218-6.CrossRefPubMed Malouf A, Norton C, Engel A, Nicholls R, Kamm M: Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet. 2000, 355: 260-265. 10.1016/S0140-6736(99)05218-6.CrossRefPubMed
21.
go back to reference Uustal Fornell E, Wingren G, Kjolhede P: Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand. 2004, 83: 383-389. 10.1111/j.0001-6349.2004.00367.x.CrossRefPubMed Uustal Fornell E, Wingren G, Kjolhede P: Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand. 2004, 83: 383-389. 10.1111/j.0001-6349.2004.00367.x.CrossRefPubMed
22.
go back to reference Kessler RC, Wethington E: The reliability of life event reports in a community survey. Psychol Med. 1991, 21: 723-738. 10.1017/S0033291700022364.CrossRefPubMed Kessler RC, Wethington E: The reliability of life event reports in a community survey. Psychol Med. 1991, 21: 723-738. 10.1017/S0033291700022364.CrossRefPubMed
Metadata
Title
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
Authors
Pelle G Lindqvist
Mats Jernetz
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2010
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-10-51

Other articles of this Issue 1/2010

BMC Pregnancy and Childbirth 1/2010 Go to the issue