Overlapping Compared With End-to-End Repair of Complete Third-Degree or Fourth-Degree Obstetric Tears: Three-Year Follow-up of a Randomized Controlled Trial

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Abstract

OBJECTIVE:

To report on a 3-year follow-up of women who underwent overlapping repair of a complete third-degree or fourth-degree obstetric tear.

METHODS:

Primiparous women sustaining a complete third-degree or a fourth-degree tear of the perineum were randomized to a primary sphincter repair using either an end-to-end or an overlapping surgical technique. At 1, 2, and 3 years, questionnaires on rates of flatal and fecal incontinence were mailed to participants.

RESULTS:

At 1 year, women who underwent an end-to-end repair reported lower rates of flatal and fecal incontinence than women who had an overlapping repair. For flatal incontinence the rates were 31% compared with 56% (95% confidence interval for the rate difference 6–43%, P=.012). For fecal incontinence, the rates were 7% compared with 16% (95% confidence interval for the rate difference −4% to 21%, P=.17). The difference between the two methods of surgical repair had largely disappeared by the end of year 2.

CONCLUSION:

At 1-year follow-up, end-to-end repair of complete third-degree or fourth-degree obstetric anal sphincter tears is associated with significantly lower rates of anal incontinence when compared with overlapping repair. There is no long-term benefit associated with either technique over the other.

CLINICAL TRIAL REGISTRATION:

ISRCTN Register, http://isrctn.org, ISRCTNO 4149919.

LEVEL OF EVIDENCE:

I

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