The levator ani muscle repair: a call to action

Tomashev, Roni; Shobeiri, S. Abbās

doi:10.1007/s10151-021-02480-1

Cited by 1 publication

(4 citation statements)

References 10 publications

(11 reference statements)

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“…In our study, 30 patients experienced postoperative complaints and 17 received prescription antibiotics. For comparison, this is rarely reported after perineal reconstructive surgery, although previous studies suggest numbers ranging between 15.6% and 20% 14,15 . Nevertheless, this might potentially be an underestimation of the complication rate, as only medical records from the Stockholm region ( n = 101) were viewed, although women from all over Sweden were included in the study.…”

Section: Discussionmentioning

confidence: 99%

“…For comparison, this is rarely reported after perineal reconstructive surgery, although previous studies suggest numbers ranging between 15.6% and 20%. 14 , 15 Nevertheless, this might potentially be an underestimation of the complication rate, as only medical records from the Stockholm region ( n = 101) were viewed, although women from all over Sweden were included in the study. However, there might also be a bias in this interpretation, as the study participants were relatively young and were encouraged to contact medical facilities with possible soreness, swelling or concern of postoperative infection or other complications.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, there is no recognized surgical technique to restore a levator ani defect, leaving women with a compromised pelvic floor support and at greater lifetime risk for pelvic organ prolapse and urinary incontinence. 15,16 The aim of the present study was to estimate the change in symptoms after perineal reconstructive surgery performed in a standardized way, in women with deficient perineum after vaginal delivery with predominant symptom of an acquired sensation of a wide vagina. Given that a LAD may impair pelvic floor support, it was hypothesized that women without LAD would report a greater reduction in symptom score than those with LAD.…”

Section: Introductionmentioning

confidence: 99%

“…This leads to difficulties in standardizing the procedure and comparing outcomes. Moreover, there is no recognized surgical technique to restore a levator ani defect, leaving women with a compromised pelvic floor support and at greater lifetime risk for pelvic organ prolapse and urinary incontinence 15,16 …”

Section: Introductionmentioning

confidence: 99%

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One‐year follow‐up after standardized perineal reconstruction in women with deficient perineum after vaginal delivery

Rotstein,

Ullemar,

Engberg

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionPerineal tears are common after childbirth and, if not surgically repaired, they may result in a deficient perineum that can cause symptoms of pelvic floor dysfunction. Perineal reconstruction aims to restore the perineal body and increase the support of the pelvic floor. The objective of the present study was to estimate symptom reduction after perineal reconstruction in patients with deficient perineum after vaginal delivery and to compare outcomes between participants with or without concomitant levator ani muscle deficiency.Material and methodsParticipants presenting at the Karolinska Pelvic Floor Center with symptoms of deficient perineum at least 1 year after vaginal birth were invited to the study. Inclusion criteria were a visible perineal scar and confirmed anatomic defect. Levator ani defects were assessed using the Levator Ani Deficiency score. A perineal reconstruction was performed in a standardized way. Subjective symptoms were evaluated using the validated “Karolinska Symptoms After Perineal Tear Inventory” at baseline and 1‐year follow‐up. A score difference in the symptom of an acquired sensation of a wide vagina was the primary outcome. Results were stratified by the presence or absence of a levator ani deficiency.ResultsA perineal reconstruction was performed in 131 patients and 128 patients completed the Karolinska Symptoms After Perineal Tear Inventory at baseline and 119 at follow‐up. Median age was 36.1 (interquartile range [IQR] 7.9), median body mass index 22.3 (IQR 5.1) and a median of two vaginal deliveries. Fifty‐four women (41.2%) had a levator ani deficiency. The mean score reduction for the item “Do you feel that your vagina is too wide/loose?” was −1.56 (SD 0.96; P < 0.001) from a mean score of 2.75 (maximum 3) at baseline. The mean total score reduction was −9.1 points (SD 5.3; P < 0.001) from a mean score of 18.4 (maximum 33) points at baseline. There were no significant differences between groups when stratifying by levator ani deficiency.ConclusionsOur results show that perineal reconstructive surgery significantly decreases symptoms of deficient perineum after vaginal delivery. A concomitant levator ani defect does not affect the symptom reduction of an acquired sensation of a wide vagina or the total score reduction after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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