Early Secondary Repair of Obstetric Anal Sphincter Injury Breakdown: Contemporary Surgical Techniques and Experiences from a Peripartum Subspecialty Clinic

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2 Scopus citations

Abstract

Objective To describe surgical technique and outcomes of early secondary repair of obstetric anal sphincter injury (OASIS) breakdown. Methods This was a case series of all women presenting to a subspecialty peripartum clinic within 2 months of an OASIS, who ultimately underwent secondary surgical repair between September 2013 and January 2018. Cases were identified using the following CPT codes: 57308 (transperineal fistula repair), 56910 (repair of the perineum), and 46750 (repair of anal sphincter). Four board-certified urogynecologists performed all surgical procedures using the same technique: demographics, delivery data, and preoperative and postoperative data were collected. Results Eighteen women were identified. The majority (16 [88.9%] of 18) were primiparous; 9 (50%) women underwent spontaneous vaginal delivery and 9 (50%) women underwent forceps-assisted vaginal delivery. Over 70% (13 [72.2%] of 18) suffered a 3rd-degree tear, whereas 5 (27.8%) of 18 had a 4th-degree laceration. The median time after delivery to specialty clinic presentation was 10 days (interquartile range, 5.3-52.5 days). All women were diagnosed with wound breakdown at their initial visit. Seven (38.9%) also had a concomitant rectovaginal fistula. Median time from diagnosis of wound breakdown to secondary operative revision was 19.5 days (interquartile range, 12-26.8 days). Seventeen (94.4%) of the 18 women underwent overlapping external anal sphincteroplasty with perineorrhaphy; of these, 7 (41.2%) also underwent concurrent repair of their rectovaginal fistula. One woman underwent perineorrhaphy alone. At 3 months postoperatively, no women had a wound breakdown or recurrent fistula. Conclusions In women with OASIS breakdown, early secondary repair is both feasible and successful with meticulous surgical technique.

Original languageEnglish (US)
Pages (from-to)E333-E335
JournalFemale Pelvic Medicine and Reconstructive Surgery
Volume27
Issue number2
DOIs
StatePublished - 2021

Keywords

  • early repair
  • obstetric anal sphincter injury
  • wound complications

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology
  • Urology

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