Elnaim Abdel Latif Khalifa, Wong Michael Pak Kai, Sagap Ismail
Department of Surgery, Kassala Police Hospital, Kassala, Sudan.
Sunway Medical Center, Kuala Lumpur, Malaysia.
Ann Med Surg (Lond). 2025 Apr 4;87(5):2555-2561. doi: 10.1097/MS9.0000000000003253. eCollection 2025 May.
Obstetric anal sphincter injuries (OASIS) represent a significant complication of childbirth, with global variation in incidence. Although overlapping sphincteroplasty is widely regarded as the gold-standard surgical treatment, managing delayed or inadequately repaired cases remains challenging. Prevention through improved obstetric practices and early recognition of injuries is considered the optimal approach to minimizing the burden of OASIS.
This case series aimed to evaluate the clinical outcomes of overlapping sphincteroplasty in patients presenting with delayed or missed OASIS.
The study included 12 female patients treated at a single institution over 4 years. All participants had a history of instrumental delivery and episiotomy, with symptoms of incontinence. Preoperative and postoperative assessments were performed using the Wexner scoring system. Overlapping sphincteroplasty was performed in all cases. Follow-up was conducted at 3 months, 6 months, 1 year, and 2 years to evaluate symptomatic improvement and patient satisfaction.
The mean age of the participants was 38 years (range: 26-53 years). All patients experienced symptomatic improvement following surgery, with significant reductions in the Wexner scores and high patient satisfaction rates. The mean duration of symptoms before surgery was 14 months (3-36 months). Complications included a 25% rate of superficial wound breakdown and one case of deep wound breakdown requiring secondary repair. Despite this, no incontinence symptoms were reported at the 2-year follow-up.
Delayed overlapping sphincteroplasty is an effective surgical approach for treating missed or inadequately repaired OASIS, offering satisfactory outcomes. However, prevention through improved obstetric practices remains an optimal strategy.
产科肛门括约肌损伤（OASIS）是分娩的一种严重并发症，全球发病率存在差异。尽管重叠式括约肌成形术被广泛认为是金标准手术治疗方法，但处理延迟或修复不充分的病例仍然具有挑战性。通过改进产科操作和早期识别损伤来预防被认为是将OASIS负担降至最低的最佳方法。
本病例系列旨在评估重叠式括约肌成形术对出现延迟或漏诊的OASIS患者的临床疗效。
该研究纳入了4年间在单一机构接受治疗的12名女性患者。所有参与者均有器械助产和会阴切开史，伴有失禁症状。术前和术后使用韦克斯纳评分系统进行评估。所有病例均进行了重叠式括约肌成形术。在3个月、6个月、1年和2年进行随访，以评估症状改善情况和患者满意度。
参与者的平均年龄为38岁（范围：26 - 53岁）。所有患者术后症状均有改善，韦克斯纳评分显著降低，患者满意度高。术前症状的平均持续时间为14个月（3 - 36个月）。并发症包括25%的浅表伤口裂开率和1例需要二次修复的深部伤口裂开。尽管如此，在2年随访时未报告失禁症状。
延迟重叠式括约肌成形术是治疗漏诊或修复不充分的OASIS的有效手术方法，效果令人满意。然而，通过改进产科操作进行预防仍然是最佳策略。
