Secondary Sphincter Repair for Anal Incontinence Following Obstetric Sphincter Injury: Functional Outcome

Authors

  • Most Bilkis Fatema Assistant Professor, Department of Colorectal Surgery, Dhaka Medical College, Dhaka.
  • Md Touhidul Islam Associate Professor, Department of Colorectal Surgery, Mymensingh Medical College, Mymensingh.
  • Tamanna Tasnim Consultant, Islami Bank Medical College, Rajshahi.
  • Arun Kumar Pal Assistant Professor, Department of Surgery, Dhaka Medical College, Dhaka.
  • Farid Uddin Ahmed Assistant Professor, Department of Surgery, Dhaka Medical College, Dhaka.
  • Mohammad Mahmudul Hassan Assistant Professor, Department of Surgery, Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka.
  • A Z Mahmudul Hasan Assistant Professor, Department of Surgery, Dhaka Medical College, Dhaka.
  • Kalyan Saha Junior Consultant (Surgery), Phase B Resident of Colorectal Surgery Department, Bangabandhu Sheikh Mujib Medical University, Dhaka.

DOI:

https://doi.org/10.3329/jss.v26i1.86081

Keywords:

Anal sphincter, Incontinence, Secondary repair, OASIS, WIS (Wexner incontinence score)

Abstract

Background: Secondary Repair of Anal Sphincter may be necessary if Primary repair of obstetric anal sphincter injuries (OASIS) is complicated by wound rupture or infection. When OASIS is treated for anal incontinence, it is considered a secondary repair even if no primary repair has been performed during the postpartum period. Home delivery and failure to reach into the health care delivery system is important cause of OASIS. The objective of this study was to assess the functional outcomes, morbidity, and impact of quality of life (QoL) following secondary repair of OASIS.

Methods: Our subject were 26 patients whose old complete perineal tear were repaired in 3 hospitals, in Dhaka city, Bangladesh over a 5-year period. The layering technique of repair was used. Function improved in 24 of 26 patients (92%) with adequate follow-up. The function was completely restored in 22 of 26 patients (85%). Data on age, incontinence to flatus, solid or liquid stools, duration of symptoms, history of the previous repair, duration of the repair, post-operative stay, complications, and recovery were collected and analyzed.

Results: A total of 26 patients underwent secondary anal sphincter repair for incontinence. The average duration of surgery was 90 minutes. The majority of patients were in the younger age groups, with a mean age of 34.0±12.1 years. The Wexner score significantly improved after surgery, decreasing from 15.12±4.34 preoperatively to 5.68±1.13 postoperatively (p<0.001). The majority of patients sought treatment relatively early after experiencing symptoms of anal incontinence, with 57.7% having symptoms for less than 1 year. The study reported a low incidence of complications, including wound infection (7.7%), anovaginal/rectovaginal fistula (3.8%), and dyspareunia (7.7%). Of the total 26 patients, two patients were lost for follow-up.

Conclusions: Following secondary repair of OASIS, the majority of symptoms and QoL significantly improve. Good insight into perineal and anal sphincter anatomy and adherence to sound principles is essential.

Journal of Surgical Sciences (2022) Vol. 26(1) : 35-41

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Published

2022-02-20

How to Cite

Fatema, M. B., Islam, M. T., Tasnim, T., Pal, A. K., Ahmed, F. U., Hassan, M. M., … Saha, K. (2022). Secondary Sphincter Repair for Anal Incontinence Following Obstetric Sphincter Injury: Functional Outcome. Journal of Surgical Sciences, 26(1), 35–41. https://doi.org/10.3329/jss.v26i1.86081

Issue

Vol. 26 No. 1 (2022)

Section

Original Articles

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