In Perineal Tear, Overlapping or End-To-End Repair Yields Similar Anal Continence

September 23, 2012

By David Douglas

NEW YORK (Reuters Health) Sep 20 - Long after a perineal tear, anal continence is similar whether repair used an overlapping or end-to-end approach -- but certain short-term results do differ, Canadian researchers say.

In their three-year follow-up study, women who had overlapping repair of a third or fourth degree obstetric anal sphincter tear had more flatal incontinence rates at one year, Dr. Scott A. Farrell told Reuters Health by email.

"It also confirmed what has been found by a number of well designed studies, that there is no significant difference in fecal incontinence rates between the two procedures," he added.

In a September 5th online paper in Obstetrics and Gynecology, Dr. Farrell of Dalhousie University Halifax and colleagues note that if the external anal sphincter must be repaired after an obstetric perineal laceration, anal incontinence often ensues, for at least a while.

It's unclear whether outcome eventually may be better following traditional end-to-end surgical repair or via overlapping repair, they said.

The 174 primiparous women in their study had all sustained a complete third- or fourth-degree tear of the perineum and agreed to be randomly assigned to repair with one or the other technique.

Follow-up questionnaires on rates of flatal and fecal incontinence were mailed to participants. Response rates were 85% at one year, 77% at two years, and 55% at three years. Similar proportions in both groups replied, and there were no significant differences in demographic or obstetric variables between women who responded and those who did not.

At one year, flatulence incontinence was reported by significantly fewer women with end-to-end vs overlapping repair (31% vs 56%). Fecal incontinence was also lower (7% vs 16%).

By the second year, however, the difference in flatulence incontinence had largely disappeared (46% vs 51%), as had the difference in fecal incontinence rates (22% vs 13%).

By three years, findings were similar for flatulence (39% vs 41%) and fecal incontinence (16% in each group).

The researchers stress, "This is the first trial to enroll exclusively primiparous women with complete tears of the external anal sphincter and to follow-up these women for a significant time interval after treatment."

They conclude, "Obstetricians must weigh the importance of the higher rate of flatal incontinence found with the overlapping repair in the first year of follow-up on their patients' quality of life. Longer-term evidence from this study, although compromised by loss to follow-up, shows no advantage of one procedure over the other."

Overall, added Dr. Farrell, "Based upon these results we would conclude that the traditional end-to-end repair is most likely to result in patient satisfaction."


Obstet Gynecol 2012.