Management of obstetric anal sphincter injury: Colorectal surgeons’ perspectives in Australia and New Zealand

Abstract

Background Obstetric anal sphincter injuries (OASIs) are a significant complication of vaginal delivery, and a leading cause of anal incontinence in women. Aims The aims were to explore the management of OASIs in Australia and New Zealand (ANZ) by colorectal surgeons and how this compares with current recommendations and international experience, and to identify the deterrents to the provision of best‐practice care among colorectal surgeons. Materials and Methods Three hundred colorectal surgeons of the Colorectal Surgical Society of ANZ were mailed questionnaires. Areas of interest included: surgeon demographics; exposure to OASIs; understanding of current recommendations; and opinions regarding the importance of symptoms and assessment tools in OASIs. Results There were 94 completed questionnaires (response rate 31.3%). Fifty‐seven surgeons (60.6%) reported low exposure to OASIs during their fellowship training. Greater than 90% believed patients with grade three tears and above should have anal sphincter assessment. Sixty‐six (70.2%) reported that they routinely review women who have had OASIs. However, 56.4% were unaware if their obstetrics department followed a standard protocol for OASIs. Surgeons practising in metropolitan centres reported higher rates of their obstetrics department following a protocol (P = 0.013), and greater access to investigative tools (P < 0.001), when compared to rural‐based surgeons. Conclusions Most ANZ colorectal surgeons have had minimal training in OASI management. Colorectal surgeons are more commonly involved with OASI patients in the non‐acute setting. Management protocols involving a multidisciplinary team of both colorectal surgeons and obstetricians should be clearly defined, and the gap between metropolitan and rural centres needs to be reviewed.

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

“…Accurate determination of sphincter damage and providing appropriate anatomical reconstruction of the sphincters is crucial in the treatment of OA-SIS. Therefore, it is recommended that the sphincters be identified and repaired by experienced surgical teams (18). In our study, the perineal body structures and sphincters of patients that developed OASIS were repaired separately by experienced surgeons immediately after delivery.…”

UK survey of colorectal surgeons on the management of acute obstetric anal sphincter injuries

“…In a survey in Australia and New Zealand, 91.4% stated that they were not routinely called to perform a primary repair of OASIs [11].…”

“…60.6% of the 94 surgeons reported low exposure to OASIs [11]. It was reported that colorectal surgeons were more commonly involved with OASI patients in the non-acute setting [11].…”

Welcome to ANZJOG 2021

“…In this issue of ANZJOG , Oh et al . report on the experience, including training and frequency of exposure to cases, of colorectal surgeons across Australia and New Zealand 6 . They find some important deficiencies in the management of OASI and recommend a multidisciplinary team involving both obstetricians and surgeons as the standard of care for these injuries.…”

“…Obstetric anal sphincter injuries (OASI) are a significant complication of vaginal birth and a leading cause of anal incontinence in women. In this issue of ANZJOG, Oh et al report on the experience, including training and frequency of exposure to cases, of colorectal surgeons across Australia and New Zealand 6. They find some important deficiencies in the management of OASI and recommend a multidisciplinary team involving both obstetricians and surgeons as the standard of care for these injuries.In the following article, Peiris-John et al step up to the challenge, identifying all audits undertaken in eight New Zealand public hospitals during 2005-2014, to determine whether women diagnosed with third-or fourth-degree perineal tears were receiving the care recommended in their relevant guidelines 7.…”