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Title: Overlapping Repair Inferior to End-to-End Repair for Third-Degree Obstetrical Lacerations: Presented at AUGS
URL: http://www.pslgroup.com/dg/22AF92.htm
Doctor's Guide
September 5, 2008

By Laura Gater

CHICAGO -- September 5, 2008 -- End-to-end repair of third- or fourth-degree obstetrical lacerations results in lower rates of flatal incontinence at 6 months in primiparous women, according to research presented here at the American Urogynecologic Society 19th Annual Scientific Meeting (AUGS).

Scott A. Farrell, MD, Urogynaecology Division, Department of Urogynaecology, Dalhousie University, Halifax, Nova Scotia, Canada, presented on September 4 the results of a study that compared rates of flatal and faecal incontinence achieved with the 2 surgical procedures -- overlapping repair and end-to-end repair -- and to correlate symptoms with external anal sphincter anatomy and function.

This randomised double-blind trial enrolled 124 vaginally primiparous women with a third- or fourth-degree tear of the external anal sphincter. Sixty-two women in each group were required to detect a difference in flatal incontinence rates of 25%.

Standardised and validated questionnaires were administered to each patient at baseline and at 6 months. Evaluation measures at 6 months were endoanal ultrasound and anal manometry. Outcome measures at 6 months were symptoms of anal continence, endoanal ultrasound, anal manometry, and subsequent follow-up annually.

Subjects had a high rate of sphincter defects after primary repair and these were associated with significant symptoms, according to the researchers. Overlapping repair showed a decreased rate of defects.

Obstetrical factors did not influence surgical outcomes, Dr. Farrell noted.

The flatal incontinence rate was higher in the overlapping-repair group compared with the end-to-end repair group (60% vs 37%; odds ratio [OR] 2.5, confidence interval [CI] 1.2, 5.2). Faecal incontinence rates were 15% with overlapping repair and 8% with end-to-end repair, neither of which achieved statistical significance (OR 2.04, CI .64, 6.5).

The researchers concluded that overlapping repair is inferior to the traditional end-to-end procedure for external tears of the anal sphincter in prevention of anal incontinence.

In addition, the researches concluded that sphincter anatomy and resting tone have no effect on flatal incontinence. Sustained voluntary contraction and overall resting tone, however, do affect anal continence.


[Presentation title: The Anal Continence Trial: A Randomized Comparison of Overlapping Versus End-to-End Repair of Third-Degree Obstetrical Laceration. Paper 4]

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