WP7.5 - Primary Repair of Obstetric Anal Sphincter Injuries (OASIS): a Survey of Surgeons’ Experience

Abstract

Abstract Purpose OASIS is associated with devastating consequences; namely incontinence. Timely, satisfactory repair of OASIS is necessary to mitigate the risk of maternal morbidity. Primary repair is typically undertaken by an obstetrician. In cases of profound anatomical disruption, the on-call surgeon may be called. The aim was to explore the experience and current practice of surgeons in the acute repair of OASIS. Methods A cross-sectional, observational study was performed. Registrars and consultants who participate in an on-call rota in the UK were included. The survey was disseminated to members of ASGBI and ACPGBI. It was also advertised via social media platforms, including Twitter and LinkedIn. A chain-sampling method was advocated. A descriptive analysis of the data was undertaken. Results 318 responses have been recorded so far. 32% of surgeons had been contacted to assist in an acute repair, of which 23% had a specialist interest in pelvic floor surgery. Of those who were contacted, 53% would typically be called for a 3c or 4 tear. Of these, 73% had not performed any primary repairs over the preceding year. 77% of all respondents had not received any training. Of those awarded the FRCS, 36% were not confident at all in performing an acute repair. Conclusion There remains a lack of consensus on who is responsible for the repair of these injuries. Surgeon involvement should only occur if adequate exposure and training is assured. Involvement may be reserved for cases where secondary repair is considered, when specialist pelvic floor opinion should be sought.