Early Secondary Repair of Obstetric Anal Sphincter Injury Breakdown: Contemporary Surgical Techniques and Experiences From a Peripartum Subspecialty Clinic. Issue 2 (February 2021)

• Record Type: Journal Article
• Authors: Lewicky-Gaupp, Christina; Mueller, Margaret G.; Collins, Sarah A.; Tavathia, Meera; Geynisman-Tan, Julia; Kenton, Kimberly S.
• Is Part Of: Female pelvic medicine & reconstructive surgery. Volume 27:Issue 2(2021)
• Publication Date: 2021-02
• Subjects: obstetric anal sphincter injury -- early repair -- wound complications; Pelvis -- Diseases -- Periodicals; Pelvis -- Surgery -- Periodicals; Genital Diseases, Female -- surgery -- Periodicals; Urologic Diseases -- surgery -- Periodicals; Colonic Diseases -- surgery -- Periodicals; Rectal Diseases -- surgery -- Periodicals; Surgical Procedures, Operative -- methods -- Periodicals; 616.6
• DOI: 10.1097/SPV.0000000000000921
• Languages: English
• ISSNs: 2151-8378

Abstract

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.