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Methods of repair for obstetric anal sphincter injury

  1. Ruwan J Fernando1,*,
  2. Abdul H Sultan2,
  3. Christine Kettle3,
  4. Ranee Thakar2

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 8 DEC 2013

Assessed as up-to-date: 2 OCT 2013

DOI: 10.1002/14651858.CD002866.pub3


How to Cite

Fernando RJ, Sultan AH, Kettle C, Thakar R. Methods of repair for obstetric anal sphincter injury. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD002866. DOI: 10.1002/14651858.CD002866.pub3.

Author Information

  1. 1

    St Mary's Hospital, Imperial College Healthcare NHS Trust, Department of Urogynaecology, London, UK

  2. 2

    Croydon University Hospital NHS Trust, Department of Obstetrics and Gynaecology, Croydon, UK

  3. 3

    Staffordshire University, Faculty of Health Sciences, Staffordshire, UK

*Ruwan J Fernando, Department of Urogynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK. ruwan.fernando@imperial.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 DEC 2013

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Farrell 2012 {published data only}
  • Farrell SA, Flowerdew G, Gilmour D, Turnbull GK, Schmidt MH, Baskett TF, et al. 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. Obstetrics and Gynecology 2012;120(4):803-8. [PUBMED: 22955309]
  • Farrell SA, Gilmour D, Turnbull GK, Schmidt MH, Baskett TF, Flowerdew G, et al. Overlapping compared with end-to-end repair of third- and fourth-degree obstetric anal sphincter tears: a randomized controlled trial. Obstetrics & Gynecology 2010;116(1):16-24.
  • Farrell SA, Gilmour D, Turnbull GK, Schmidt MH, Baskett TF, Flowerdew G, et al. Randomized trial of overlapping versus end-to-end repair of third or fourth degree EAS tears: three year follow-up of anal incontinence symptoms. Neurourology & Urodynamics 2011;30(6):1192.
Fernando 2006 {published data only}
  • Fernando RJ, Sultan AH, Kettle C, Radley S, Jones P, O'Brien PM. Repair techniques for obstetric anal sphincter injuries: a randomized controlled trial. Obstetrics & Gynecology 2006;107(6):1261-8.
  • Fernando RJ, Sultan AH, Kettle C, Radley S, Jones PW, O'Brien PMS. Management of obstetric anal sphincter injuries - a randomised controlled study of repair techniques. Unpublished data (as supplied 2005). Data on file.
  • Fernando RJ, Sultan AH, Kettle C, Radley S, Jones PW, O'Brien PMS. Obstetric anal sphincter injury - repair technique and outcome. Colorectal Disease 2004;6(Suppl 1):24.
  • Fernando RJ, Sultan AH, Kettle C, Radley S, Jones PW, O'Brien PMS. Obstetric anal sphincter repair and anal continence - a randomised controlled study. Abstracts of 30th British Congress of Obstetrics & Gynaecology; 2004 July 7-9; Glasgow, UK. 2004:14.
  • Fernando RJ, Sultan AH, Kettle C, Radley S, O'Brien PMS. Obstetric anal sphincter injury - does repair technique affect the outcome?. BJOG: an international journal of obstetrics and gynaecology 2004;111:1151.
Fitzpatrick 2000 {published data only}
  • Fitzpatrick M, Behan M, O'Connell PR, O'Herlihy C. A randomised controlled trial comparing primary overlap with approximation repair of third-degree obstetric tears. American Journal of Obstetrics and Gynecology 2000;183(5):1220-4.
  • Fitzpatrick M, Behan M, O'Connell PR, O'Herlihy C. A randomised controlled trial of primary repair of third degree perineal tears, comparing overlap and approximation techniques [abstract]. American Journal of Obstetrics and Gynecology 2000;182(1 Pt 2):S37.
  • Fitzpatrick M, Cassidy M, Behan M, O'Connell PR, O'Herlihy C. Primary anal sphincter repair: influence of technique of repair [abstract]. Colorectal Disease 1999;1(Suppl 1):10.
Garcia 2005 {published data only}
  • Garcia V, Rogers RG, Kim SS, Hall RJ, Kammerer-Doak DN. Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques. American Journal of Obstetrics and Gynecology 2005;192:1697-701.
Rygh 2010 {published data only}
Williams 2006 {published data only}
  • Williams A, Adams EJ. Third degree perineal repair: a randomised controlled trial comparing two suture materials and two repair techniques. Unpublished data (as supplied 2005). Data on file.
  • Williams A, Adams EJ, Tincello DG, Alfirevic Z, Walkinshaw SA, Richmond DH. How to repair an anal sphincter injury after vaginal delivery: results of a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2006;113(2):201-7.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Goh 2004 {published data only}
  • Goh J, Carey M, Tjandra J. Direct end-to-end or overlapping delayed anal sphincter repair for anal incontinence: long-term results of a prospective randomised study. Neurourology and Urodynamics 2004;23:412-4.
  • Tjandra JJ, Han WR, Goh J, Carey M, Dwyer P. Direct repair vs overlapping sphincter repair - a randomised controlled trial. Diseases of the Colon & Rectum 2003;46(7):937-42.
Johansson 2005 {published data only}
  • Johansson C, Nordenstam J, Zetterstrom J, Lopez A, Anzen B, Parker SC, et al. Anal sphincter injuries at childbirth: a randomized study comparing urgent and delayed repair. Colorectal Disease 2005; Vol. 7, issue Suppl 1:35.
  • Nordenstam J, Mellgren A, Altman D, Lopez A, Johansson C, Anzen B, et al. Immediate or delayed repair of obstetric anal sphincter tears-a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2008; Vol. 115, issue 7:857-65.
Lindqvist 2010 {published data only}
  • Lindqvist PG, Jernetz M. A modified surgical approach to women with obstetric anal sphincter tears by separate suturing of external and internal anal sphincter. A modified approach to obstetric anal sphincter injury. BMC Pregnancy and Childbirth 2010;10:51.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Johanson 2001 {published data only}
  • The REPAIR study: recognition and expertise of in the prevention of anal incontinence from ruptured sphincter. Personal communication 2001.
  • Ismail KMK, Kettle C, O'Mahoney F, Lucking L, Tapp A, Jones PW. Recognition and expertise in the prevention of anal incontinence from ruptured sphincter (REPAIR): a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2008; Vol. 115, issue s1:133.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Al-Mufti 1996
Browning 1983
Bugg 2001
  • Bugg GJ, Kiff ES, Hosker G. A new condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence. BJOG: an international journal of obstetrics and gynaecology 2001;108(10):1057-67.
Buppasiri 2005
Clarkson 2001
  • Clarkson JC, Newton C, Bick D, Gyte G, Kettle C, Newburn M, et al. Achieving sustainable quality in maternity services - using audit of incontinence and dyspareunia to identify shortfalls in meeting standards. BMC Pregnancy and Childbirth 2001;1(1):4.
Combs 1990
Continence Foundation 2000
  • The Continence Foundation. Incontinence: a challenge and an opportunity for primary care. The Continence Foundation Information Leaflet. London: The Continence Foundation, 2000.
Corman 1980
DOH 2000
  • Department of Health. Good Practice in Continence Services. London: Department of Health, 2000.
Eddy 1999
  • Eddy A. Litigating and quantifying maternal damage following childbirth. Clinical Risk 1999;5(5):178-80.
Farrell 2011
  • Farrell SA, Gilmour D, Turnbull GK, Schmidt MH, Baskett TF, Flowerdew G, et al. Randomized trial of overlapping versus end-to-end repair of third or fourth degree EAS tears: three year follow-up of anal incontinence symptoms. Neurourology & Urodynamics 2011;30(6):1192.
Fenner 2003
  • Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JOL. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetric unit in the United States. American Journal of Obstetrics and Gynecology 2003;189:1543-50.
Fernando 2000
  • Fernando RJ, Sultan AS, Johanson RB, Radley S, Jones PW. Management of obstetric anal sphincter injury - a systematic review and national practice survey. BMC Health Service Research 2002;2(1):9.
Fitzpatrick 2001
Giebel 1993
  • Giebel GD, Mennigen R, Chalabi KH. Secondary anal reconstruction after obstetric injury. Coloproctology 1993;1:55-8.
Gjessing 1998
Glazener 1995
Glazener 1997
Glazener 1998
  • Glazener CMA, Lang G, Wilson PD, Herbison GP, Macarthur C, Gee H. Postnatal incontinence: a multicentre randomised controlled trial of conservative treatment. British Journal of Obstetrics and Gynaecology 1998;105:47-50.
Goldberg 1980
Gurol-Urganci 2013
  • I Gurol-Urganci, DA Cromwell, LC Edozien, TA Mahmood, EJ Adams, DH Richmond, A Templeton, JH van der Meulen. Third- and fourth-degree perineal tears amongprimiparous women in England between 2000and 2012: time trends and risk factors. British Journal of Obstetrics & Gynaecology 2013;120(12):1516–1525.
Haadem 1987
Haadem 1988
  • Haadam K, Ohrlander S, Lingman G. Long term ailments due to anal sphincter rupture caused by delivery: a hidden problem. European Journal of Obstetrics & Gynecology and Reproductive Biology 1988;27(1):27-32.
Haadem 1990
  • Haadem K, Dahlstrom JA, Lingman G. Anal sphincter function after delivery: a prospective study in women with sphincter rupture and controls. European Journal of Obstetrics & Gynecology and Reproductive Biology 1990;35(1):7-13.
Higgins 2011
  • Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Ismail 2008
  • Ismail KMK, Kettle C, O'Mahoney F, Lucking L, Tapp A, Jones PW. Recognition and expertise in the prevention of anal incontinence from ruptured sphincter (REPAIR): a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2008; Vol. 115, issue s1:133.
Johanson 1996
Jorge 1993
Koelbl 2009
  • Koelbl H, Nitti V, Baessler K, Salvatore S, Sultan A, Yamaguchi O. Pathophysiology of urinary incontinence, faecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L, Khoury, Wein A editor(s). Incontinence. 4th Edition. Plymouth: Health Publication Ltd, 2009:293-5.
Macarthur 1991
  • Macarthur C, Lewis M, Knox EG. Health after Childbirth: an Investigation of long term health problems beginning after childbirth in 11701 women. London: The Stationery Office, 1991:83-103.
Mellgren 1999
  • Mellgren A, Jensen LL, Zetterstrom JP, Wong WD, Hofmeister JH, Lowry AC. Long term cost of faecal incontinence secondary to obstetric injuries. Diseases of the Colon & Rectum 1999;42:857-67.
Milsom 2009
  • Milsom I, Altman D, Lapitan MC, Nelson R, Sillen U, Thom D. Epidemiology of urinary and faecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L, Khoury, Wein A editor(s). Incontinence. 4th Edition. Plymouth: Health Publication Ltd, 2009:73.
NICE 2011
  • CG132. Caesarean section: NICE guideline. NICE 23 November 2011.
Nordenstam 2008
  • Nordenstam J, Mellgren A, Altman D, Lopez A, Johansson C, Anzen B, et al. Immediate or delayed repair of obstetric anal sphincter tears-a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2008; Vol. 115, issue 7:857-65.
Norton 2002
  • Norton C, Christiansen J, Butler U, Harari D, Nelson RL, Pemberton J, et al. Anal incontinence. In: Abrams P, Cardozo L, Khoury, Wein A editor(s). Incontinence. 2. Plymouth: Health Publication Ltd, 2002:985-1044.
Pezim 1987
  • Pezim ME, Spencer RJ, Stanhope CR, Beart RW Jr, Ready RL, Ilstrup DM. Sphincter repair for faecal incontinence after obstetrical or iatrogenic injury. Diseases of the Colon & Rectum 1987;30:521-5.
Poen 1997
RCOG 2007
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Rockwood 2000
  • Rockwood TH, Church JM, Fleshman JW, Kane RL. Faecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Diseases of the Colon & Rectum 2000;43:17-24.
Rogers 2007
  • Rogers RG, Fenner DE. Rectovaginal fistulas. In: Sultan AH, Thakar R, Fenner DE editor(s). Perineal and Anal Sphincter Trauma. 1st Edition. London: Springer- Verlag, 2007:168.
Rothenberger 1982
Sangalli 1994
Sleep 1991
  • Sleep J. Perineal care: a series of five randomized controlled trials. In: Robinson S, Thomson A editor(s). Midwives, Research and Childbirth. 1st Edition. Vol. 1, London: Chapman and Hall, 1991:199-251.
Sorensen 1988
Sultan 1993
Sultan 1994a
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Sultan 1994b
Sultan 1995
  • Sultan AH, Kamm MA, Hudson CN. Obstetric perineal trauma: an audit of training. Journal of Obstetrics and Gynaecology 1995;15:19-23.
Sultan 1997
  • Sultan AH, Kamm MA. Faecal incontinence after childbirth. British Journal of Obstetrics and Gynaecology 1997;104:972-82.
Sultan 1999a
Sultan 1999b
  • Sultan AH. Obstetric perineal injury and anal incontinence. Clinical Risk 1999;5:193-6.
Sultan 2002
Sultan 2007
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Tetzschner 1996
Tjandra 2003
Uustal Fornell 1996
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Vaizey 1999
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Walsh 1996
Wheeless 1998
  • Wheeless CR Jr. Ten steps to avoid faecal incontinence secondary to fourth degree obstetrical tear. Obstetrical and Gynecological Survey 1998;53(3):131-2.
Wood 1998

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Fernando 2000a
  • Fernando R, Johanson R, Kettle C, Sultan A, Radley S. Methods of repair for obstetric anal sphincter injury. Cochrane Database of Systematic Reviews 2000, Issue 4. [DOI: 10.1002/14651858.CD002866]
Fernando 2006