Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jul;32(7):1611-1622.
doi: 10.1007/s00192-021-04822-x. Epub 2021 May 15.

Early secondary repair of obstetric anal sphincter injuries (OASIs): experience and a review of the literature

Nicola Adanna Okeahialam  1 , Ranee Thakar  1   2 , Abdul H Sultan  3   4
Affiliations
Review

Early secondary repair of obstetric anal sphincter injuries (OASIs): experience and a review of the literature

Nicola Adanna Okeahialam et al. Int Urogynecol J. 2021 Jul.

Abstract

Introduction and hypothesis: Secondary anal sphincter repair for a dehisced obstetric anal sphincter injury (OASI) is required following 2.6% of primary repairs. There is growing evidence that instead of delaying repair for 3-6 months, early secondary repair of the anal sphincter can be completed within 14 days. Our aims were to review the literature and to describe experiences in our unit.

Methods: This is a narrative review of all published cases reporting outcomes of early secondary repair of dehisced OASIs. In addition, we report a series from Croydon University Hospital (CUH) between 2010 and 2019.

Results: Ninety patients from five studies were identified on literature search. Six patients from CUH were included in the case series. Overall, the most common complications following secondary repair included skin dehiscence [10.3% (n = 10)], infection [5.2% (n = 5)] and fistula formation [8.2% (n = 8)]. In our case series, following secondary repair, normal manometric incremental squeeze pressure was found in five women (83%). Also, on endoanal ultrasound, internal anal sphincter (IAS) defects were found in 75% with a history of IAS injury (n = 4). There were no full-thickness external anal sphincter defects. Compared to those requiring primary repair alone, residual defects were significantly larger in those who also underwent secondary repair (Starck score 2.1 vs. 5.7, p = 0.01).

Conclusion: Early secondary repair is a feasible surgical procedure for the reconstruction of dehisced OASIs. This case series and review of the literature can be used to support clinicians in the management of primary OASI repair dehiscence.

Keywords: Anal incontinence; Anal sphincter repair; Early secondary sphincter repair; Obstetric anal sphincter injury.

PubMed Disclaimer

References

    1. Stock L, Basham E, Gossett DR, Lewicky-Gaupp C. Factors associated with wound complications in women with obstetric anal sphincter injuries (OASIS). Am J Obstet Gynecol. 2013;208:327.e1–6. https://doi.org/10.1016/j.ajog.2012.12.025 . - DOI
    1. Goldaber KG, Wendel PJ, McIntire DD, Wendel GD. Postpartum perineal morbidity after fourth-degree perineal repair. Am J Obstet Gynecol. 1993;168:489–93. https://doi.org/10.1016/0002-9378(93)90478-2 . - DOI - PubMed
    1. Soerensen MM, Bek KM, Buntzen S, et al. Long-term outcome of delayed primary or early secondary reconstruction of the anal sphincter after obstetrical injury. Dis Colon Rectum. 2008;51:312–7. https://doi.org/10.1007/s10350-007-9084-4 . - DOI - PubMed
    1. Arona AJ, Al-Marayati L, Grimes DA, Ballard CA. Early secondary repair of third- and fourth-degree perineal lacerations after outpatient wound preparation. Obstet Gynecol. 1995;86:294–6. https://doi.org/10.1016/0029-7844(95)00128-e . - DOI - PubMed
    1. Hankins GD, Hauth JC, Gilstrap LC, et al. Early repair of episiotomy dehiscence. Obstet Gynecol. 1990;75:48–51. - PubMed

LinkOut - more resources