Short and long term results of anatomical reconstruction of perineal body and sphincter complex in obstetric anal sphincter injuries
Ali Kemal Kayapınar1
, Durmuş Ali Çetin1, Zehra Betül Paköz2, Kübra Karakolcu3, İbrahim Egemen Ertaş3, Kemal Erdinç Kamer1
1Clinic of General Surgery, Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Türkiye
2Clinic of Gastroenterology, Atatürk Training and Research Hospital, Katip Çelebi University Faculty of Medicine, İzmir, Türkiye
3Clinic of Obstetrics and Gynecology, Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Türkiye
Abstract
Objective: The effective way to reduce the risk of fecal incontinence (FI) in primary repaired obstetric anal sphincter injuries (OASIS) patients is to accurately detect the injury and provide complete anatomical reconstruction. The aim of the study was to evaluate the short-term and long-term results of OASIS cases that were diagnosed by an experienced surgical team and whose perineal body and anal sphincters were reconstructed separately.
Material and Methods: Sixteen patients that required consultations due to anal sphincter damage during vaginal delivery and underwent anatomical reconstruction due to Grade 3c and Grade 4 sphincter damage between 2007 and 2019 were included in the study. These cases were divided into three groups [Group 1 (≤12 months), Group 2 (12-60 months), Group 3 (≥60 months)] according to the time elapsed until anal manometry, and incontinence questionnaires were conducted in the postoperative period. Recto-anal inhibitory reflex (RAIR), mean resting (IB) and squeezing (SB) pressures were measured by anal manometry. Anal incontinence (AI) and FI rates were determined by questionnaires. Anal sphincter damage repair techniques (overlapping, end-to-end) were determined. These parameters were compared between the three groups.
Results: Mean age of the patients was 27.5 (16-35) years. Six (37.5%) patients had Grade 3c, while 10 (62.5%) had Grade 4 injury. The overall mean RP and SP were 35 (26-56) mmHg and 67 (31-100) mmHg, respectively. Mean RP and SP were 46/67 mmHg, 33.5/75.5 mmHg, and 37.5/70.5 mmHg in Groups 1, 2, and 3 respectively. There was no difference between the three groups in terms of mean RP and SP (p= 0.691, p= 0.673). The rate of AI and FI in all patients were 18.75% and 12.5%, respectively while the rate of severe AI incontinence was 6%. Severe AI was observed in 1 (16.7%) case in Group 1, mild AI was observed in 1 (25%) case in group 2, and in 1 (16.7%) case in Group 3. RAIR was positive in all patients. In Group 1, 5 (83.3%) patients underwent overlapping repair, and in Group 3, 6 (100%) patients underwent end-to-end repair. This difference was statistically significant (p= 0.011).
Conclusion: In vaginal births, evaluation of anal sphincter damage, determination of perineal body structures and anal sphincters separately and performing anatomical reconstruction when needed significantly reduce the rate of FI in the short and long term.
Keywords: Obstetric anal sphincter injuries, anal incontinence, fecal incontinence, perineal body, anal manometry, Wexner score
Cite this article as: Kayapınar AK, Çetin DA, Paköz ZB, Karakolcu K, Ertaş İE, Kamer KE. Short and long term results of anatomical reconstruction of perineal body and sphincter complex in obstetric anal sphincter injuries. Turk J Surg 2022; 38 (2): 159-168.
This study was approved by İzmir Tepecik Health Practice Research Center Non-invasive Ethics Committee (Decision no: 2019/18-14, Date: 26.12.2019).
Externally peer-reviewed.
Concept - A.K.K.; Design - A.K.K.; Supervision - K.E.K.; Data Collection and/or Processing - Z.B.P., K.K., İ.E.E., A.K.K.; Analysis and/or Interpretation - A.K.K., D.A.Ç.; Literature Search - A.K.K., D.A.Ç.; Writing Manuscript - A.K.K., D.A.Ç.; Critical Reviews - K.E.K..
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.