Objective: To compare the incidence of persistent sonographic anal
sphincter defect, fecal urgency, anal and fecal incontinence after IIIb-
IV degree perineal rupture repair using overlapping and end-to-end
technique.
Method: An open clinical trial with randomization was carried out in
July 2010-April 2012. The population consisted of the patients who
underwent vaginal delivery in Dr. Sardjito Central General Hospital,
Sleman District General Hospital, as well as Tegalrejo, Jetis and Mergangsan
Community Health Centers who did no have complaints of
fecal urgency, anal incontinence, and/or fecal incontinence, and suffered
IIIb-IV degree perineal rupture repaired within less than 24
hours of rupture. The exclusion criteria included conditions in which
patients could not undergo repair at the moment (shock, uncooperative
patient). Fourty-eight research samples were divided into 2
groups, 24 samples for each of the treatment group (overlapping repair)
and the control group (end-to-end repair). Local anesthesia was
performed in a pudendal-block manner.
Result: Success of the repair was assessed based on the presence of
persistent sonographic anal sphincter defects in the 6-week evaluation
after repair. Successful repair was higher in the overlapping group
than that of the end-to-end group (94.74% vs 81.25%, p=0.31).
Clinically and based on the Fecal Continence Scoring Scale (FCSS),
evaluation at weeks II and VI indicated successful repair in both
groups.
Conclusion: There was no difference in the incidence of persistent
sonographic anal sphincter defects, fecal urgency, anal incontinence,
and fecal incontinence, after IIIb-IV degree perineal rupture repair
using overlapping technique in comparison with end-to-end technique.
Keywords: end-to-end technique, III-IV degree perineal rupture,
obstetric perineal rupture, overlapping technique
Is endoanal, introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence?
