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Residual defects of the external anal sphincter following primary repair: an observational study using transperineal ultrasound
Author(s) -
Shek K. L.,
GuzmanRojas R.,
Dietz H. P.
Publication year - 2014
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.13368
Subject(s) - medicine , tears , fecal incontinence , levator ani , odds ratio , avulsion , surgery , external anal sphincter , sphincter , vaginal delivery , anal sphincter , anal canal , pelvic floor , pregnancy , rectum , biology , genetics
Objectives Obstetric anal sphincter tears are common and an important factor in the etiology of anal incontinence. The objective of the study was to evaluate the prevalence of residual defects of the external anal sphincter ( EAS ) after primary repair of obstetric anal sphincter injury using four‐dimensional ( 4D ) transperineal ultrasound and to correlate sonographic findings of residual defects and levator avulsion with significant symptoms of anal incontinence, defined as St Mark's fecal incontinence score ( SMIS ) of ≥ 5. Methods This was a retrospective observational study. One‐hundred and forty women were seen after primary repair of obstetric anal sphincter tears in a dedicated perineal clinic at a tertiary hospital in Australia. They all underwent a standardized interview, and physical and 4D transperineal ultrasound examination. Results Mean follow‐up interval was 1.9 months after delivery. Eighty‐nine (64%) women had a 3a/3b tear, 28 (20%) a 3c/4 th degree tear and 23 (16%) an unclassified 3 rd degree tear. Thirty‐five (25%) patients reported symptoms of anal incontinence. Nine had an SMIS of ≥ 5. A residual defect was found in 56 (40%) cases and levator avulsion in 27 (19%). On multivariate logistic regression, residual defects ( P = 0.03; odds ratio ( OR ) = 6.38; 95% CI , 1.23–33.0) and levator avulsion ( P = 0.047; OR = 4.38; 95% CI , 1.02–18.77) were found to be independent risk factors for anal incontinence. Conclusions Residual defects of the EAS were found on transperineal ultrasound in 40% of women after primary repair of obstetric anal sphincter injuries. Although most were asymptomatic, residual anal sphincter defects and levator avulsion were associated with significant symptoms of anal incontinence as quantified using the SMIS . Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.