From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
Female Pelvic Med Reconstr Surg. 2021 Feb 1;27(2):e333-e335. doi: 10.1097/SPV.0000000000000921.
To describe surgical technique and outcomes of early secondary repair of obstetric anal sphincter injury (OASIS) breakdown.
This was a case series of all women presenting to a subspecialty peripartum clinic within 2 months of an OASIS, who ultimately underwent secondary surgical repair between September 2013 and January 2018. Cases were identified using the following CPT codes: 57308 (transperineal fistula repair), 56910 (repair of the perineum), and 46750 (repair of anal sphincter). Four board-certified urogynecologists performed all surgical procedures using the same technique: demographics, delivery data, and preoperative and postoperative data were collected.
Eighteen women were identified. The majority (16 [88.9%] of 18) were primiparous; 9 (50%) women underwent spontaneous vaginal delivery and 9 (50%) women underwent forceps-assisted vaginal delivery. Over 70% (13 [72.2%] of 18) suffered a 3rd-degree tear, whereas 5 (27.8%) of 18 had a 4th-degree laceration. The median time after delivery to specialty clinic presentation was 10 days (interquartile range, 5.3-52.5 days). All women were diagnosed with wound breakdown at their initial visit. Seven (38.9%) also had a concomitant rectovaginal fistula.Median time from diagnosis of wound breakdown to secondary operative revision was 19.5 days (interquartile range, 12-26.8 days). Seventeen (94.4%) of the 18 women underwent overlapping external anal sphincteroplasty with perineorrhaphy; of these, 7 (41.2%) also underwent concurrent repair of their rectovaginal fistula. One woman underwent perineorrhaphy alone. At 3 months postoperatively, no women had a wound breakdown or recurrent fistula.
In women with OASIS breakdown, early secondary repair is both feasible and successful with meticulous surgical technique.
描述产科肛门括约肌损伤（OASIS）破裂的早期二次修复手术技术和结果。
这是一个病例系列研究，纳入了 2013 年 9 月至 2018 年 1 月期间在 OASIS 发生后 2 个月内到一个专病围产期门诊就诊的所有女性。使用以下 CPT 代码确定病例：57308（经会阴瘘修复术）、56910（会阴修复术）和 46750（肛门括约肌修复术）。四位经过董事会认证的泌尿科妇科医生使用相同的技术进行所有手术：收集人口统计学、分娩数据以及术前和术后数据。
确定了 18 名女性。大多数（18 名中的 16 名[88.9%]）为初产妇；9 名（50%）女性经阴道分娩，9 名（50%）女性经产钳助产分娩。超过 70%（18 名中的 13 名[72.2%]）发生 3 度撕裂，而 18 名中的 5 名（27.8%）发生 4 度撕裂。从分娩到专科诊所就诊的中位时间为 10 天（四分位间距，5.3-52.5 天）。所有女性在初次就诊时均被诊断为伤口破裂。7 名（38.9%）女性还伴有直肠阴道瘘。从伤口破裂诊断到二次手术修复的中位时间为 19.5 天（四分位间距，12-26.8 天）。18 名女性中有 17 名（94.4%）行重叠的肛门外括约肌成形术加会阴修补术；其中 7 名（41.2%）还同时修复了直肠阴道瘘。1 名女性仅行会阴修补术。术后 3 个月，无女性出现伤口破裂或复发性瘘。
在 OASIS 破裂的女性中，采用精细的手术技术进行早期二次修复既可行又成功。
