Long-Term Results after Early Secondary Repair of Obstetric Anal Sphincter Injury: A Case Series and Literature Review.

Abstract

Introduction and hypothesis: The incidence of obstetric anal sphincter injury (OASI) is 3.6-6% of women with vaginal deliveries. Complications to OASI are common, and secondary repair is needed in 2.6-3%. Traditionally, secondary repair has been postponed until wound healing, but studies have shown that early secondary repair within 21 days can be safely performed.

Methods: The aim of this cohort study and literature review was to investigate the long-term outcomes after early secondary repair with focus on anal incontinence, quality of life and impact on sexual function with the use of International Consultation on Incontinence Questionnaire-Bowel (ICIQ-B).

Results: A total of 17 patients underwent early secondary repair after OASI within the study period and 11 answered and returned the long-term follow-up questionnaire. Seven had no postoperative complications, nine had infection and two developed recto-vaginal fistulas that needed subsequent surgical treatment. Median follow-up period was 5 years (2.3-5.7). At long-term, ten women (91%) reported fecal urgency, nine (82%) flatal and liquid incontinence, six (55%) problems with soiling and six (55%) unpredictable bowel accidents. Five women (45%) planned daily activities to accommodate their anal incontinence and three (27%) stayed at home because of anal incontinence. Seven women (64%) reported restrictions in their sexual relations due to anal incontinence.

Conclusions: In conclusion, early secondary repair of OASI in women with severe wound dehiscence involving the anal sphincter may be necessary. However, this group have a high risk of anal incontinence, negative impact on quality of life, and risk of sexual dysfunction at long-term follow-up.