M Barbosa1, M Glavind-Kristensen2, P Christensen2,3. 1. Pelvic Floor Unit, Department of Gynecology and Obstetrics, Aarhus University Hospital, 8200, Aarhus N, Denmark. malopint@rm.dk. 2. Pelvic Floor Unit, Department of Gynecology and Obstetrics, Aarhus University Hospital, 8200, Aarhus N, Denmark. 3. Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, 8200, Aarhus N, Denmark.
Abstract
BACKGROUND: An early secondary repair of the anal sphincter may be necessary if primary repair of obstetric anal sphincter injury (OASIS) is complicated by wound rupture or severe infection. The objective of this study was to assess the long-term functional outcomes, morbidity, and impact on quality of life (QoL) following an early secondary repair of OASIS. METHODS: This retrospective cohort study was conducted at Aarhus University Hospital, Denmark. All women having a secondary repair of the anal sphincter within 21 days of delivery from February 1991 to February 2017 were included (n = 51). Complications were assessed by reviewing medical records. The patient-reported outcomes were assessed in 2018 by questionnaires. Primary outcome was Wexner score and St. Mark's score. Impact on QoL was assessed using the Fecal Incontinence Quality of Life Scale (FIQLS). RESULTS: After a median follow-up time of 6.7 years (IQR 3.3-16.6), 34 women completed the questionnaire. The mean (SD) Wexner score was 5.2 ± 4.7 and the mean (SD) St. Mark's score was 6.8 ± 5.7. Women with a Wexner score ≥ 9 had a significantly lower QoL score in all domains of the FIQLS compared to women with a Wexner score < 9 (p < 0.001). Postoperative complications were experienced by 37%. Ten women developed a fistula of which nine required surgical treatment. CONCLUSIONS: An early secondary repair of the anal sphincter can be performed within 21 days of delivery with functional long-term outcomes comparable to those following a late sphincter repair. However, there is an imminent risk of complications, mainly fistulas, which should be taken into consideration when choosing the ideal timing of the repair.
BACKGROUND: An early secondary repair of the anal sphincter may be necessary if primary repair of obstetric anal sphincter injury (OASIS) is complicated by wound rupture or severe infection. The objective of this study was to assess the long-term functional outcomes, morbidity, and impact on quality of life (QoL) following an early secondary repair of OASIS. METHODS: This retrospective cohort study was conducted at Aarhus University Hospital, Denmark. All women having a secondary repair of the anal sphincter within 21 days of delivery from February 1991 to February 2017 were included (n = 51). Complications were assessed by reviewing medical records. The patient-reported outcomes were assessed in 2018 by questionnaires. Primary outcome was Wexner score and St. Mark's score. Impact on QoL was assessed using the Fecal Incontinence Quality of Life Scale (FIQLS). RESULTS: After a median follow-up time of 6.7 years (IQR 3.3-16.6), 34 women completed the questionnaire. The mean (SD) Wexner score was 5.2 ± 4.7 and the mean (SD) St. Mark's score was 6.8 ± 5.7. Women with a Wexner score ≥ 9 had a significantly lower QoL score in all domains of the FIQLS compared to women with a Wexner score < 9 (p < 0.001). Postoperative complications were experienced by 37%. Ten women developed a fistula of which nine required surgical treatment. CONCLUSIONS: An early secondary repair of the anal sphincter can be performed within 21 days of delivery with functional long-term outcomes comparable to those following a late sphincter repair. However, there is an imminent risk of complications, mainly fistulas, which should be taken into consideration when choosing the ideal timing of the repair.
Authors: J Rothbarth; W A Bemelman; W J Meijerink; A M Stiggelbout; A H Zwinderman; M E Buyze-Westerweel; J B Delemarre Journal: Dis Colon Rectum Date: 2001-01 Impact factor: 4.585
Authors: Alberto Bravo Gutierrez; Robert D Madoff; Ann C Lowry; Susan Congilosi Parker; W Donald Buie; Nancy N Baxter Journal: Dis Colon Rectum Date: 2004-03-25 Impact factor: 4.585
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Malou Barbosa; Peter Christensen; Karl Møller-Bek; Lise Brogaard; Marianne Glavind-Kristensen Journal: Int Urogynecol J Date: 2021-03-17 Impact factor: 2.894
Authors: Anna-Lena Stickelmann; Lieven Nils Kennes; Miriam Hölscher; Charlotte Graef; Tomas Kupec; Julia Wittenborn; Elmar Stickeler; Laila Najjari Journal: BMC Womens Health Date: 2022-08-10 Impact factor: 2.742