Immediate or Delayed Repair of Obstetric Anal Sphincter Tears–A Randomized Controlled Trial

Abstract

This randomized, controlled trial examined the influence of delaying primary repair for 8 to 12 hours in 165 women seen in a 28-month period who had a third- or fourth-degree perineal tear. Immediate end-to-end repair was carried out in 78 women, whereas 87 had delayed repair. Patients completed a questionnaire dealing with incontinence and pelvic floor symptoms at the outset and after a 6- to 12-month follow-up interval. Both questionnaires were completed by more than 90% of participants. The degree and frequency of symptoms were similar in the 2 groups at baseline, and no significant group differences were noted when comparing rates of flatus incontinence, liquid stool incontinence, solid stool incontinence, fecal urgency, or the inability to distinguish between flatus and feces. Adjusted Pescatori incontinence scores increased significantly in both groups and remained elevated after 12 months despite improving slightly. Analysis based on a multivariate proportional odds model disclosed that increasing maternal age correlated significantly with increased symptoms of fecal urgency and also with difficulty distinguishing between feces and flatus. Delaying primary repair of third- and fourth-grade perineal tears for up to 12 hours, whereas not routinely recommended, may be considered when surgical expertise is not immediately available.