Immediate or delayed repair of obstetric anal sphincter tears—a randomised controlled trial*

Abstract

Objective To investigate if an 8-to 12-hour time delay of primary repair affects anal incontinence at 1-year follow up.Design Randomised controlled trial.Setting University hospital in Sweden.Population A total of 165 women diagnosed with a third-to fourth-degree perineal tear.Methods The participants were randomised to immediate or delayed (8-to 12-hour delay) end-to-end repair; 78 were allocated to immediate operation and 87 to a delayed repair. An incontinence and pelvic floor symptom questionnaire was completed by the participants at baseline and at 6-and 12-month follow up.Main outcome measures Anal incontinence measured by the validated Pescatori incontinence score.Results A total of 161 (98%) and 155 (94%) women completed the two follow-up questionnaires. There was no significant difference in anal incontinence between the groups. There were no significant differences in pelvic floor symptoms between the groups. A multivariate proportional odds model revealed that increasing maternal age was significantly associated with both increased symptoms of faecal urgency and inability to discriminate flatus from faeces.Conclusion Delayed repair provided the same functional outcome at 1-year follow up. Delaying the repair should thus not be recommended routinely, but can be an alternative under special circumstances when appropriate surgical expertise is not readily available.Keywords Anal incontinence, obstetric anal sphincter tear, primary repair, randomised controlled trial.

Postpartum Traumatic Rectal Tear After Normal Vaginal Delivery with an Intact Anal Sphincter

“…With respect to time of intervention, late (up to 12 hours) repair does not seem to produce an inferior functional result 1 year after surgery, 8 although immediate surgery's main advantages are emotional comfort of the woman in this important moment of her life, control of possible active bleeding, and avoidance of tissue edema and infection. 7…”

Obstetrics anal sphincter injury and repair technique: A review

“…Sphincter repair can be deferred due to any inconvenient causes without deteriorating functional outcomes. One randomized control trial in 2008 comparing immediate repair and delayed repair (8–12‐h delay) reported that there were similar functional outcomes at the 1‐year follow‐up . Furthermore, Soerensen et al .…”

Recent Advances in Functional Anorectal Disorders

“…This paper was based on 108 patients taken from an original cohort of 165 women who were randomized to immediate or delayed end-to-end repair after a third-degree to fourthdegree perineal tear [17]. Of these 108 women, 20 had anal incontinence, predominantly for flatus; only four were incontinent for loose or solid stool and nearly 90% of these patients had a third-degree perineal tear.…”

“…Analyses focused on conditions that preceded the incidence date of FI for cases in each matched pair. In 88% of cases, FI began at age ≥40; severity was mild (37%), moderate (58%), or severe (5% [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] and stress urinary incontinence (OR, 3.1; 95% CI, 1.4-6.5), but not obstetric events, were independent risk factors for FI. These data demonstrate that bowel disturbances rather than prior obstetric injury are the main risk factors preceding the onset of FI.…”