Long-Term Results after Early Secondary Repair of Obstetric Anal Sphincter Injury: A Case Series and Literature Review.

INTRODUCTION AND HYPOTHESIS

The incidence of obstetric anal sphincter injury (OASI) is 3.6-6% of women with vaginal deliveries. Complications to OASI are common, and secondary repair is needed in 2.6-3%. Traditionally, secondary repair has been postponed until wound healing, but studies have shown that early secondary repair within 21 days can be safely performed.

METHODS

The aim of this cohort study and literature review was to investigate the long-term outcomes after early secondary repair with focus on anal incontinence, quality of life and impact on sexual function with the use of International Consultation on Incontinence Questionnaire-Bowel (ICIQ-B).

RESULTS

A total of 17 patients underwent early secondary repair after OASI within the study period and 11 answered and returned the long-term follow-up questionnaire. Seven had no postoperative complications, nine had infection and two developed recto-vaginal fistulas that needed subsequent surgical treatment. Median follow-up period was 5 years (2.3-5.7). At long-term, ten women (91%) reported fecal urgency, nine (82%) flatal and liquid incontinence, six (55%) problems with soiling and six (55%) unpredictable bowel accidents. Five women (45%) planned daily activities to accommodate their anal incontinence and three (27%) stayed at home because of anal incontinence. Seven women (64%) reported restrictions in their sexual relations due to anal incontinence.

CONCLUSIONS

In conclusion, early secondary repair of OASI in women with severe wound dehiscence involving the anal sphincter may be necessary. However, this group have a high risk of anal incontinence, negative impact on quality of life, and risk of sexual dysfunction at long-term follow-up.