End-to-end better than overlapping anal sphincter repair

January 01, 0001

End-to-end better than overlapping anal sphincter repair

These Canadian investigators compared overlapping repair with end- to-end repair of obstetric tears and to investigate which procedure results in a higher rate of flatal incontinence. They randomly assigned 149 primiparous women sustaining a complete third- or a fourth-degree tear of the perineum to a primary sphincter repair using either an end-to-end (n=75) or an overlapping surgical technique (n=74) using 3-0 polyglyconate.

They found: "Women who underwent overlapping repair compared with end- to-end repair had higher rates of flatal incontinence, 61% compared with 39% (OR 2.44). The rate of fecal incontinence was also higher, 15% compared with 8% (OR 1.97) but did not attain statistical significance. Rates of internal and external anal sphincter defects did not differ significantly between groups and did not correlate with anal incontinence symptoms. Fecal incontinence was higher when there was a defect in both sphincter muscles. Anal sphincter function as assessed by manometry did not differ significantly between groups."

The authors concluded: "End-to-end repair of third- or fourth- degree obstetric anal sphincter tears is associated with lower rates of anal incontinence when compared with overlapping repair."

The difference was modest and not statistically significant for the most important outcome of fecal incontinence.

For the full abstract, click here.

Obstet Gynecol 116(1):16-24, July 2010 © 2010 to the American College of Obstetricians and Gynecologists
Overlapping Compared With End-to-End Repair of Third- and Fourth-Degree Obstetric Anal Sphincter Tears: A Randomized Controlled Trial. Scott A. Farrell, Donna Gilmour, Geoffrey K. Turnbull, et al. Correspondence to Dr. Farrell: [email protected]

Category: W. Pregnancy, Childbirth, Family Planning. Keywords: anal sphincter, obstetric, 3rd-degree perineal lacteration, 4th- degree perineal laceration, fecal incontinence, flatal incontinence, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 3rd August 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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