Document Detail


Overlapping compared with end-to-end repair of third- and fourth-degree obstetric anal sphincter tears: a randomized controlled trial.
MedLine Citation:
PMID:  20567163     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare overlapping repair with end-to-end repair of obstetric tears and to investigate which procedure results in a higher rate of flatal incontinence.
METHODS: One-hundred forty-nine primiparous women sustaining a complete third- or a fourth-degree tear of the perineum were assigned randomly to a primary sphincter repair using either an end-to-end (n=75) or an overlapping surgical technique (n=74) using 3-0 polyglyconate. Outcome measures at 6 months included rates of flatal and fecal incontinence, quality-of-life scores, integrity of the internal and external anal sphincters by anal ultrasonography, and anal sphincter function as reflected by anal manometry.
RESULTS: Women who underwent overlapping repair compared with end-to-end repair had higher rates of flatal incontinence, 61% compared with 39% (odds ratio [OR] 2.44, confidence interval [CI] 1.2-5.0). The rate of fecal incontinence was also higher, 15% compared with 8% (OR 1.97, CI 0.62-6.3) 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.
CONCLUSION: 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.
CLINICAL TRIAL REGISTRATION: ISRCTN Register, isrctn.org, ISRCTN04149919.
LEVEL OF EVIDENCE: I.
Authors:
Scott A Farrell; Donna Gilmour; Geoffrey K Turnbull; Matthias H Schmidt; Thomas F Baskett; Gordon Flowerdew; Cora A Fanning
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  116     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-22     Completed Date:  2010-11-15     Revised Date:  2011-02-10    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  16-24     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada. scott.farrell@iwk.nshealth.ca
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN04149919
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MeSH Terms
Descriptor/Qualifier:
Adult
Anal Canal / physiology,  surgery*
Digestive System Surgical Procedures / methods*
Fecal Incontinence / etiology
Female
Flatulence
Follow-Up Studies
Humans
Obstetric Labor Complications / surgery
Perineum / injuries*
Postoperative Complications
Pregnancy
Treatment Outcome
Comments/Corrections
Comment In:
Obstet Gynecol. 2010 Jul;116(1):2-3   [PMID:  20567159 ]
Obstet Gynecol. 2011 Feb;117(2 Pt 1):408; author reply 408-9   [PMID:  21252767 ]
Obstet Gynecol. 2011 Feb;117(2 Pt 1):409; author reply 409-10   [PMID:  21252769 ]
Obstet Gynecol. 2010 Nov;116(5):1223   [PMID:  20966726 ]
Obstet Gynecol. 2010 Nov;116(5):1223; author reply 223   [PMID:  20966727 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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