Has primary overlap replaced end-to-end repair for anal sphincter rupture during vaginal delivery?

摘要

Twenty primigravidae women were included in this study. Their age ranged from (20-32) years. They were requiring primary repair for third degree tear occurring during vaginal delivery. All repairs were performed immediately after obstetric disruption. A ruptured internal sphincter was repaired separately and the torn ends of the external sphincter were overlaped in 10 women and approximated as end-to-end in the other 10 women, and sutured with 3/0 polydioxanone sulphate sutures. Sixteen women were followed up, and for all bowel function, clinical assessement, and anal endosonography were performed at a mean of 120 days after delivary. Eleven percent had persistent sonographic external sphincter defects with overlap, and 57% with end to end repair. Also, we found similar percent of internal sphincter defects with overlap, and end-to-end repair. There was no significant difference between the two techniques with regard to the clinical outcome. Based on the preceding results it would appear that sonographic image for external sphincter is better with overlap than end-to-end repair, but we can not conclusively prove that overlap is superior to the end-to-end repair for better clinical outcome obtained from both techniques.