A surgical technique for secondary repair of obstetric anal sphincter injuries; sphinctero-vagino-perineoplasty

Şimşek, Arife; Ateş, Mustafa; Dirican, Abuzer; Özgör, Dinçer

doi:10.4274/tjod.12369

Cited by 3 publications

(3 citation statements)

References 20 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In anal sphincter reconstruction in cases of obstetric trauma, while the authors did not compare the suture material, Simsec et al 13 observed improvement in fecal continence scores, which leads the present authors to understand that there was no dehiscence in the sutures or, at least that if they occurred, there was no clinical repercussion. This represents a large gap to be filled by experimental studies.…”

Section: Discussionmentioning

confidence: 62%

Evaluation of polypropylene and polyglactin sutures in primary sphincteroplasty for the treatment of anal fistula in rats

Conde

Santos

Dourado

et al. 2019

Journal of Coloproctology

View full text Add to dashboard Cite

Rationale Fistulotomy followed by primary sphincteroplasty is one of the therapeutic options in transsphincteric fistulae; however, it was not known which suture would present a better result. Objective To compare polypropylene and polyglactin sutures in primary sphincteroplasty in rats subjected to fistulotomy. Method Thirty Wistar rats were subjected to peritoneal anesthesia with ketamine and xylazine, followed by transfixation of the anal sphincter with steel thread, which remained for 30 days to develop the anal fistula. After this period, the steel thread was removed and four groups were formed: A – Control ( n = 5), without treatment; B – Fistulotomy ( n = 5), performed fistulotomy only; C – Polypropylene ( n = 10), in which fistulotomy was performed followed by primary sphincteroplasty with polypropylene suture; D – Polyglactin ( n = 10), in which fistulotomy was performed followed by primary sphincteroplasty with polyglactin suture; after 30 days the animals were anesthetized again and submitted to euthanasia by deepening the anesthetic plane to remove the specimens, analyzing fistula closure, muscle fiber distance, and inflammatory process. Results The fistula persisted in all animals of the control group and in none of the other groups; the distances between the muscle fibers were 1620 μm, 4665 μm, and 2520 μm, respectively in Groups B, C, and D ( p = 0.067); in relation to fibrosis, the means were 2.4, 2.8, and 3.6, respectively in Groups B, C, and D, showing greater fibrosis in the latter group ( p = 0.041). Conclusion There was no persistence of the fistula in any of the treated animals; there was no difference in the distance between the muscle fibers between the groups subjected to primary sphincteroplasty with polypropylene or polyglactin, or between these groups and the one treated only by fistulotomy. There was greater fibrosis in animals treated with primary sphincteroplasty with polyglactin.

show abstract

Section: Discussionmentioning

confidence: 62%

Evaluation of polypropylene and polyglactin sutures in primary sphincteroplasty for the treatment of anal fistula in rats

Conde

Santos

Dourado

et al. 2019

Journal of Coloproctology

View full text Add to dashboard Cite

show abstract

“…Pudendal nerve neuropraxia may develop due to nerve traction during vaginal delivery. This can also cause temporary (28). However, AI due to pudendal nerve injury has not been elucidated in the majority of studies (29).…”

Section: Discussionmentioning

confidence: 99%

Short and long term results of anatomical reconstruction of perineal body and sphincter complex in obstetric anal sphincter injuries

et al. 2022

View full text Add to dashboard Cite

Objective: The effective way to reduce the risk of fecal incontinence (FI) in primary repaired obstetric anal sphincter injuries (OASIS) patients is to accurately detect the injury and provide complete anatomical reconstruction. The aim of the study was to evaluate the short-term and long-term results of OASIS cases that were diagnosed by an experienced surgical team and whose perineal body and anal sphincters were reconstructed separately. Material and Methods: Sixteen patients that required consultations due to anal sphincter damage during vaginal delivery and underwent anatomical reconstruction due to Grade 3c and Grade 4 sphincter damage between 2007 and 2019 were included in the study. These cases were divided into three groups [Group 1 (≤12 months), Group 2 (12-60 months), Group 3 (≥60 months)] according to the time elapsed until anal manometry, and incontinence questionnaires were conducted in the postoperative period. Recto-anal inhibitory reflex (RAIR), mean resting (IB) and squeezing (SB) pressures were measured by anal manometry. Anal incontinence (AI) and FI rates were determined by questionnaires. Anal sphincter damage repair techniques (overlapping, end-to-end) were determined. These parameters were compared between the three groups. Results: Mean age of the patients was 27.5 (16-35) years. Six (37.5%) patients had Grade 3c, while 10 (62.5%) had Grade 4 injury. The overall mean RP and SP were 35 (26-56) mmHg and 67 (31-100) mmHg, respectively. Mean RP and SP were 46/67 mmHg, 33.5/75.5 mmHg, and 37.5/70.5 mmHg in Groups 1, 2, and 3 respectively. There was no difference between the three groups in terms of mean RP and SP (p= 0.691, p= 0.673). The rate of AI and FI in all patients were 18.75% and 12.5%, respectively while the rate of severe AI incontinence was 6%. Severe AI was observed in 1 (16.7%) case in Group 1, mild AI was observed in 1 (25%) case in group 2, and in 1 (16.7%) case in Group 3. RAIR was positive in all patients. In Group 1, 5 (83.3%) patients underwent overlapping repair, and in Group 3, 6 (100%) patients underwent end-to-end repair. This difference was statistically significant (p= 0.011). Conclusion: In vaginal births, evaluation of anal sphincter damage, determination of perineal body structures and anal sphincters separately and performing anatomical reconstruction when needed significantly reduce the rate of FI in the short and long term.

show abstract

“…Faecal incontinence can be caused by a range of factors (neuropathic, traumatic, congenital, iatrogenic) [11] and when related to obstetric trauma the degree of the tear (third and fourth) is related to increased risk of incontinence [12]. The time of repair of the OASIS whether primary (immediately after birth) or secondary (delayed after days/weeks) seems to impact on the incidence of incontinence as results of primary repair, especially performed by experienced surgeons, are superior to secondary repair [13].…”

mentioning

confidence: 99%

A systematic review and a meta‐analysis on the incidence of obstetric anal sphincter injuries during vaginal delivery

Orlando,

Thomas,

Murphy

et al. 2023

Colorectal Disease

View full text Add to dashboard Cite

AimThe incidence of obstetric anal sphincter injuries (OASIS) has increased in the past two decades despite improved awareness of the risk factors. This study aimed to define the incidence of OASIS in women with different features (instrumental delivery or other variables).MethodsA systematic review was conducted on articles reporting the incidence of OASIS. This review aims to examine the association of instrumentation and OASIS by performing a formal systematic review of the published literature. Databases used for the research were MEDLINE, Embase, CINAHL and ‘Maternity and infant care’ databases.ResultsTwo independent reviewers screened the selected articles. 2326 duplicates were removed from the total of 4907 articles. The remaining 2581 articles were screened for title and abstract. 1913 articles were excluded due to irrelevance. The remaining 300 were screened as full text. Primiparity associated with the use of forceps were the features associated with the highest incidence of OASIS in the selected articles (19.4%). OASIS in all women had an overall incidence of 3.8%. The incidence of OASIS in all women by geographical region was the highest (6.5%) in North America.ConclusionsThere are various factors that impact on the incidence of OASIS and the combination of some of these, such as the use of forceps in primiparas, resulted in the highest incidence of OASIS. The lack of international consensus is limiting the improvements that can be done to reduce OASIS rates and improve best clinical practice.

show abstract

A surgical technique for secondary repair of obstetric anal sphincter injuries; sphinctero-vagino-perineoplasty

Cited by 3 publications

References 20 publications

Evaluation of polypropylene and polyglactin sutures in primary sphincteroplasty for the treatment of anal fistula in rats

Evaluation of polypropylene and polyglactin sutures in primary sphincteroplasty for the treatment of anal fistula in rats

Short and long term results of anatomical reconstruction of perineal body and sphincter complex in obstetric anal sphincter injuries

A systematic review and a meta‐analysis on the incidence of obstetric anal sphincter injuries during vaginal delivery

Contact Info

Product

Resources

About