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Immediate or delayed repair of obstetric anal sphincter tears—a randomised controlled trial *
Author(s) -
Nordenstam J,
Mellgren A,
Altman D,
López A,
Johansson C,
Anzén B,
Li Zhongze,
Zetterström J
Publication year - 2008
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.1471-0528.2008.01726.x
Subject(s) - medicine , pelvic floor , fecal incontinence , randomized controlled trial , anal sphincter , tears , surgery
Objective To investigate if an 8‐ to 12‐hour time delay of primary repair affects anal incontinence at 1‐year follow up. Design Randomised controlled trial. Setting University hospital in Sweden. Population A total of 165 women diagnosed with a third‐ to fourth‐degree perineal tear. Methods The participants were randomised to immediate or delayed (8‐ to 12‐hour delay) end‐to‐end repair; 78 were allocated to immediate operation and 87 to a delayed repair. An incontinence and pelvic floor symptom questionnaire was completed by the participants at baseline and at 6‐ and 12‐month follow up. Main outcome measures Anal incontinence measured by the validated Pescatori incontinence score. Results A total of 161 (98%) and 155 (94%) women completed the two follow‐up questionnaires. There was no significant difference in anal incontinence between the groups. There were no significant differences in pelvic floor symptoms between the groups. A multivariate proportional odds model revealed that increasing maternal age was significantly associated with both increased symptoms of faecal urgency and inability to discriminate flatus from faeces. Conclusion Delayed repair provided the same functional outcome at 1‐year follow up. Delaying the repair should thus not be recommended routinely, but can be an alternative under special circumstances when appropriate surgical expertise is not readily available.