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01-04-2008 | Original Contribution

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

Authors: A. Lepistö, Ph.D., T. Pinta, Ph.D., M.-L. Kylänpää, Ph.D., E. Halmesmäki, Ph.D., T. Väyrynen, M.D., A. Sariola, M.D., V. Stefanovic, Ph.D., A. Aitokallio-Tallberg, Ph.D., V.-M. Ulander, Ph.D., P. Molander, Ph.D., P. Luukkonen, Ph.D.

Published in: Diseases of the Colon & Rectum | Issue 4/2008

Abstract

Purpose

This study was designed to evaluate prospectively the results of the overlap technique in primary sphincter reconstruction after obstetric tear.

Methods

Obstetric tears in 44 women were operated on with primary overlap reconstruction. These women were investigated six to nine months after the operation. Results were compared with those of a historical control group of 52 women whose obstetric sphincter rupture had been treated with the end-to-end technique.

Results

The overlap group had significantly more incontinence symptoms after delivery and repair of the sphincter tear than before delivery (P < 0.0001); however, their incontinence symptoms were significantly fewer than those of the end-to-end group (P = 0.004). The prevalence of persistent rupture of the external anal sphincter was significantly lower in the overlap group (6/44, 13.6 percent) than in the end-to-end group (39/52, 75 percent; P < 0.0001). Internal anal sphincter rupture occurred in 5 patients (11.4 percent) in the overlap group and in 40 patients (76.9 percent) in the end-to-end group (P < 0.0001).

Conclusions

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

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.PubMedCrossRef

Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal sphincter disruption during vaginal delivery. N Engl J Med 1993;329:1905–11.PubMedCrossRef

Nielsen MB, Hauge C, Pedersen JF, Christiansen J. Anal endosonographic findings in the follow-up of primarily sutured sphincteric ruptures. Br J Surg 1992;79:104–6.PubMedCrossRef

Walsh CJ, Mooney EF, Upton GJ, Motson RW. Incidence of third degree perineal tears in labour and outcome after primary repair. Br J Surg 1996;83:218–21.PubMedCrossRef

Fornell EK, Berg G, Hallbook O, Matthiesen LS, Sjödahl R. Clinical consequences of anal sphincter rupture during vaginal delivery. J Am Coll Surg 1996;183:553–8.PubMed

Pirhonen JP, Grenman SE, Haadem K, et al. 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;77:974–7.PubMedCrossRef

Cook TA, Mortensen NJ. Management of fecal incontinence following obstetric injury. Br J Surg 1998;85:293–9.PubMedCrossRef

de Leeuw JW, Vierhout ME, Struijk PC, Wallenburg HC. Risk factors for third-degree perineal ruptures during delivery. BJOG 2001;108:383–7.PubMedCrossRef

Baghestan E, Bördahl PE, Rasmussen SA, Sande AK, Lyslo I, Solvang I. A validation of the diagnosis of obstetric sphincter tears in two Norwegian databases, the Medical Birth Registry and the Patient Administration System. Acta Obstet Gynecol Scand 2007;86:205–9.PubMedCrossRef

10.

Crawford LA, Quint EH, Pearl ML, Delancey JO. Incontinence following rupture of the anal sphincter during delivery. Obstet Gynecol 1993;82:527–31.PubMedCrossRef

11.

Kamm MA. Obstetric damage and fecal incontinence. Lancet 1994;344:730–3.PubMedCrossRef

12.

Varma A, Gunn J, Gardiner A, Lindow SW, Duthie GS. Obstetric anal sphincter injury: prospective evaluation of incidence. Dis Colon Rectum 1999;42:1537–43.PubMedCrossRef

13.

Pollack J, Nordenstam J, Brismar S, et al. Anal incontinence after vaginal delivery: a five-year prospective cohort study. Obstet Gynecol 2004;104:1397–402.PubMed

14.

Zetterström J, Lopez A, Holmström B, et al. Obstetric sphincter tears and anal incontinence: an observational follow-up study. Acta Obstet Gynecol Scand 2003;82:921–8.PubMedCrossRef

15.

Lal M, Mann H, Callender R, Radley S. Does cesarean delivery prevent anal incontinence? Obstet Gynecol 2003;101:305–12.PubMedCrossRef

16.

Harkin R, Fitzpatrick M, O’Connell PR, O’Herlihy C. Anal sphincter disruption at vaginal delivery: is recurrence predictable? Eur J Obstet Gynecol Reprod Biol 2003;109:149–52.PubMedCrossRef

17.

Pinta T, Kylänpää-Bäck M-L, Salmi T, Järvinen JH, Luukkonen P. Delayed sphincter repair for obstetric ruptures: analysis of failure. Colorectal Dis 2003;5:73–8.PubMedCrossRef

18.

Pinta T, Kylänpää M-L, Salmi T, Teramo K, Luukkonen P. Primary sphincter repair: are the results good enough? Dis Colon Rectum 2004;47:18–23.PubMedCrossRef

19.

Coats PM, Chan KK, Wilkins M, Beard RJ. A comparison between midline and mediolateral episiotomies. Br J Obstet Gynaecol 1980;87:408–12.PubMed

20.

Klein MC, Gauthier RJ, Robbins JM, et al. Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation? Am J Obstet Gynecol 1994;171:591–8.PubMed

21.

Riskin-Mashiah S, O’Brian SE, Wilkins IA. Risk factors for severe perineal tear: can we do better? Am J Perinatol 2002;19:225–34.PubMedCrossRef

22.

Bek KM, Laurberg S. Risks of anal incontinence from subsequent vaginal delivery after a complete obstetric anal sphincter tear. Br J Obstet Gynaecol 1992;99:724–6.PubMed

23.

Henriksen TB, Bek KM, Hedegaard M, Secher NJ. Episiotomy and perineal lesions in spontaneous vaginal deliveries. Br J Obstet Gynaecol 1992;99:950–4.PubMed

24.

Groutz A, Fait G, Lessing JB, et al. Incidence and obstetric risk factors of postpartum anal incontinence. Scand J Gastroenterol 1999;34:315–8.PubMedCrossRef

25.

Poen AC, Felt-Bersma RJ, Dekker GA, et al. Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy. Br J Obstet Gynaecol 1997;104:563-6.PubMed

26.

Dahl C, Kjolhede P. Obstetric anal sphincter rupture in older primiparous women: a case-control study. Acta Obstet Gynecol Scand 2006;85:1252–8.PubMedCrossRef

27.

Kearney R, Miller JM, Ashton-Miller JA, Delancey JO. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol 2006;107:144–9.PubMed

28.

Sultan AH, Kamm MA, Hudson CN, Bartram C. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 1994;308:887–91.PubMed

29.

Poen AC, Felt-Bersma RJ, Srijers RL, et al. Third-degree obstetric perineal tear: long-term clinical and functional results after primary repair. Br J Surg 1998;85:1433–8.PubMedCrossRef

30.

Kammere-Doak DN, Wesol AB, Rogers RG, Dominguez CE, Dorin MH. A prospective cohort study of women after primary repair of obstetric anal sphincter laceration. Am J Obstet Gynecol 1999;181:1317–22.CrossRef

31.

Davis K, Kumar D, Stanton SL, et al. Symptoms and anal sphincter morphology following primary repair of third-degree tears. Br J Surg 2003;90:1573–9.PubMedCrossRef

32.

Kairaluoma MV, Raivio P, Aarnio MT, Kellokumpu IH. Immediate repair of obstetric anal sphincter rupture: medium-term outcome of the overlap technique. Dis Colon Rectum 2004;47:1358–63.PubMedCrossRef

33.

Sultan AH, Monga AK, Kumar D, Stanton SL. Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol 1999;106:318–23.PubMed

34.

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;107:1261–8.PubMed

35.

Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.PubMedCrossRef

36.

Bartram CI, Sultan AH. Anal endosonography in faecal incontinence. Gut 1995;37:4–6.PubMedCrossRef

37.

Pedersen IK, Christiansen J. A study of the physiological variation in anal manometry. Br J Surg 1989;76:69–70.PubMedCrossRef

38.

Fitzpatrick M, Behan M, O’Connell PR, O’Herlihy C. A randomized clinical trial compared primary overlap with approximation repair of third-degree obstetric tears. Am J Obstet Gynecol 2000;183:1220–4.PubMedCrossRef

39.

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;192:1697–701.PubMedCrossRef

40.

Rothbarth J, Bemelman WA, Meijerink WJ, Buyze-Westerweel ME, van Dijk JG, Delemarre JB. Long-term results of anterior anal sphincter repair for fecal incontinence due to obstetric injury / with invited comments. Dig Surg 2000;17:390–3.PubMedCrossRef

41.

Nazir M, Stien R, Carlsen E, Jacobsen AF, Nesheim BI. Early evaluation of bowel symptoms after primary repair of obstetric perineal rupture is misleading: an observational cohort study. Dis Colon Rectum 2003;46:1245–50.PubMedCrossRef

42.

Fornell EU, Matthiesen L, Sjödahl R, Berg G. Obstetric anal sphincter injury ten years after: subjective and objective long term effects. BJOG 2005;112:312–6.PubMedCrossRef

43.

Nazir M, Carlsen E, Nesheim BI. Do occult anal sphincter injuries, vector volume manometry and delivery variables have any predictive value for bowel symptoms after first time vaginal delivery without third and fourth degree rupture? A prospective study. Acta Obstet Gynecol Scand 2002;81:720–6.PubMedCrossRef

Title: Overlap Technique Improves Results of Primary Surgery after Obstetric Anal Sphincter Tear
Authors: A. Lepistö, Ph.D.
T. Pinta, Ph.D.
M.-L. Kylänpää, Ph.D.
E. Halmesmäki, Ph.D.
T. Väyrynen, M.D.
A. Sariola, M.D.
V. Stefanovic, Ph.D.
A. Aitokallio-Tallberg, Ph.D.
V.-M. Ulander, Ph.D.
P. Molander, Ph.D.
P. Luukkonen, Ph.D.
Publication date: 01-04-2008
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 4/2008
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-007-9182-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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