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Sir,

In their article about repairing anal sphincter injury following vaginal delivery, Williams et al.1 state that there is no difference in maternal morbidity associated with any particular type of suture material. In the Royal College of Obstetricians and Gynaecologists guideline No. 29,2 management of third and fourth degree perineal tears following vaginal delivery, it is suggested as a good practice point that the use of monofilament sutures such as polydioxanone, compared with sutures such as catgut or polyglactin suture materials, may be associated with less infection and better long-term function of the anal sphincter complex. Would this statement now, in the author’s opinion, be invalid?

Do the authors feel that it is justified to include tear of the internal anal sphincter in the universal classification when nothing is done per se for the repair at the time of trauma? In this trial, there were no separate attempts made to identify and repair the internal anal sphincter, and it is suggested that functional assessment using questionnaire alone was the most important tool at postnatal follow up for sphincter injuries.

We would be interested to receive your thoughts.

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