Incidence and risk factors for secondary failure after acute obstetric sphincter injury repair – an audit of 239 women. (13th September 2022)

• Record Type: Journal Article
• Authors: Jain, Anshini; Lew, Chen; Thungathruthi, Kaushik; Ng, Suat Chin; Hiscock, Richard; Mirbagheri, Naseem
• Is Part Of: Colorectal disease. Volume 25:Number 1(2023)
• Page Start: 95
• Page End: 101
• Publication Date: 2022-09-13
• Subjects: obstetric sphincter injury -- postpartum -- endoanal ultrasound -- manometry -- incidence; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.16313
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: The rate of secondary failure after obstetric sphincter injury repair is unknown, with the literature reporting rates ranging from 0.1% to 53%. We aimed to perform an audit to identify the rate and risk factors for failure of sphincter repair in a cohort of postpartum women using endoanal ultrasound (EAUS) and manometry, assessing the risk factors and impact of these events. Method: Prospective data were collected within a 2 year period from patients who attended the perineal clinic at Eastern Health. Variables of primary repair and presence of postpartum complications were recorded and subsequently analysed. Results: Of 239 patients with obstetric anal sphincter injury (OASI) included, 100 (41.8%) had EUAS evidence of sphincter defects. Only 20% with secondary repair failure were symptomatic with faecal or flatal incontinence at a mean follow‐up of 23.4 months postpartum. Patients with secondary repair failure had lower anal resting ( p = 0.006) and maximum squeeze pressures compared with patients with intact repairs ( p < 0.001). In terms of variables that were investigated, namely location, operator hierarchy, type of repair and material used, none had a statistically significant correlation with secondary repair failure of OASI. Postpartum complications had an overall incidence of 12.7%, and those with any complication were found to have an increased rate of secondary failure of repair ( p = 0.157). Conclusion: Using EAUS to confirm secondary failure of repair, incidence was 41.4% in this cohort. There were no identifiable modifiable variables that reduced the risk of secondary failure of repair. Further prospective research with increased sample size and longer follow‐up periods is required to assess the validity of the findings.