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How to repair an anal sphincter injury after vaginal delivery: results of a randomised controlled trial
Author(s) -
Williams Abimbola,
Adams Elisabeth J,
Tincello Douglas G,
Alfirevic Zarko,
Walkinshaw Stephen A,
Richmond David H
Publication year - 2006
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2006.00806.x
Subject(s) - medicine , vicryl , surgery , childbirth , randomized controlled trial , quality of life (healthcare) , fibrous joint , anal sphincter , population , vaginal delivery , pregnancy , nursing , biology , genetics , environmental health
Objective To compare two surgical techniques and two types of suture material for anal sphincter repair after childbirth‐related injury. Design Factorial randomised controlled trial. Setting Tertiary referral maternity unit. Population Women with an anal sphincter injury sustained during childbirth. Method Women were randomised into four groups: overlap repair with polyglactin (Vicryl); end‐to‐end repair with polyglactin (Vicryl); overlap repair with polydioxanone (PDS); and end‐to‐end repair with PDS. All repairs were completed as a primary procedure by staff trained in both methods. Main outcome measures Suture‐related morbidity at six weeks. Bowel symptoms at 3, 6 and 12 months. Anorectal physiology at three months. Quality of life scores at 3 and 12 months. Results One hundred and fifty women (1.5% of deliveries) were eligible and 112 (75%) were randomised. One hundred and three (92%) attended follow up visit at 6 weeks, 89 (80%) at 3 months, 79 (71%) at 6 months and 60 (54%) at 12 months. At six weeks, there was no difference in suture‐related morbidity between groups ( P = 0.11) and 70% patients were completely asymptomatic. Incidence of bowel symptoms and quality of life disturbances were low, with no differences between the four groups. Conclusion Obstetric anal sphincter repair carried out by appropriately trained staff is associated with low morbidity, irrespective of the suture material and repair method used.