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

• Published in: Diseases of the colon & rectum Vol. 51; no. 4; pp. 421 - 425
• Main Authors: Lepistö, A., Pinta, T., Kylänpää, M.-L., Halmesmäki, E., Väyrynen, T., Sariola, A., Stefanovic, V., Aitokallio-Tallberg, A., Ulander, V.-M., Molander, P., Luukkonen, P.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-04-2008; The ASCRS; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Anal Canal - diagnostic imaging; Anal Canal - injuries; Anal Canal - physiopathology; Biological and medical sciences; Colonoscopy; Colorectal Surgery; Defecation; Delivery, Obstetric - adverse effects; Digestive System Surgical Procedures - methods; Endosonography; Female; Follow-Up Studies; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Manometry; Medical sciences; Medicine; Medicine & Public Health; Oncology; Original Contribution; Pressure; Retrospective Studies; Rupture; Surgery; Surgical Oncology; Suture Techniques; Treatment Outcome; Wounds and Injuries - diagnosis; Wounds and Injuries - etiology; Wounds and Injuries - surgery; Obstetric tear; Overlap repair; Delivery; Treatment; Surgery; Gastroenterology; Technique; Anal sphincter
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/s10350-007-9182-3

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.