SURGICAL TREATMENT OF OBSTETRIC ANAL SPHINCTER INJURY – CASE SERIES

Case Presentation A 29-year-old woman, a first-time mother, had a vaginal delivery assisted by a doctor with the need for an episiotomy, resulting in a fourth-degree perineal tear. A second case involved a 30-year-old woman who had a vaginal delivery and a third-degree tear. The first patient gave birth in 2018 and had a Wexner score of 12 points, while the second patient gave birth in early 2024 with a Wexner score of 13 points.

Discussion Obstetric anal sphincter injury can result in mild to severe fecal incontinence, with symptoms possibly appearing immediately after childbirth or decades later. The incidence is higher in women who experience more severe perineal tears, grades III or IV, or those who require an episiotomy. Diagnosis is made at the time of delivery and can be confirmed through endoanal ultrasonography, which detects the anatomical defect, and by high-resolution anorectal manometry, which assesses functional deficits of the sphincter complex and identifies the location of muscular failure through vectorgrams. Surgical treatment yields good functional results, particularly in the short- and medium-term. Studies show that in the long-term, women may experience recurring complaints of fecal incontinence, either mild or severe. In the patients described here, anal sphincteroplasty with muscle overlap and skin flap transposition to augment or create the perineal body was performed. Despite the time elapsed between the injury and surgery, both patients had good functional outcomes for their anal sphincter apparatus.

Conclusion Surgical treatment is required for obstetric anal sphincter injury, and despite the various techniques available, muscle overlap is superior to others. This technique can be performed even when surgery is delayed.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025