Open AccessThe overlap technique versus end‐to‐end approximation technique for primary repair of obstetric anal sphincter rupture: a randomized controlled study
Author(s) -
Rygh Astrid Betten,
Körner Hartwig
Publication year - 2010
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.3109/00016349.2010.512073
Subject(s) - medicine , fecal incontinence , endoanal ultrasound , anal sphincter , anorectal manometry , randomized controlled trial , surgery , sphincter , anal canal , defecation , rectum
Objective . To compare the outcome of end‐to‐end approximation versus the overlap technique for primary repair of obstetric anal sphincter rupture (OASR) at 12 month follow‐up. Design . Prospective, randomized controlled study. Setting . University hospital. Sample . One hundred and twenty‐eight patients with grade 3b, 3c or 4 OASR were randomized; 119 (end‐to‐end 60, overlap 59) received the allocated treatment. We obtained information concerning fecal incontinence from 101 (85%) patients. Methods . The obstetric team on call performed the repairs. Wexner score, endoanal ultrasound (EAUS), and manometry were used to evaluate anal sphincter function at 12 months post‐surgery. Main outcome measures . Primary outcome was incidence of solid stool leakage at least once a week. Secondary outcomes were flatus incontinence, Wexner score, external anal muscle defect examined by EAUS, and anal manometry results. Results . One patient in the end‐to‐end group and none in the overlap group reported leakage of solid stool once a week or more. Fourteen patients in the end‐to‐end group and 10 in the overlap group reported flatus incontinence ( p = 0.48). Mean Wexner score was similar in both groups, 2.4 versus 2.2. One patient in the end‐to‐end group and none in the overlap group had a Wexner score >10 (severe anal incontinence) (NS). External sphincter defect was found in 2/46 in the end‐to‐end group compared to 0/41 in the overlap group (NS). Anal manometry findings were similar in both groups. Conclusion . The overlap repair was not superior to the approximation technique with regard to fecal incontinence at 12 months.