Primary repair of obstetric anal sphincter laceration: A randomized trial of two surgical techniques

Objective: This study was undertaken to compare surgical techniques for the primary repair of obstetric anal sphincter lacerations. Study design: Patients with complete third- or fourth-degree lacerations were recruited and randomly assigned to either an end-to-end or overlapping repair. Data collection included demographic data, obstetric history, and intrapartum events. Postpartum, women completed incontinence questionnaires and underwent physical and ultrasound examinations. To detect a 36% difference between groups with an a =.05 and b =.20, 30 patients were required. Data were analyzed with Student t test and c2 analysis. Results: Forty-one women were randomly assigned;, 23 to an end-to-end and 18 to an overlapping repair. Twenty-seven percent of women underwent episiotonly and 61% operative vaginal delivery. Follow-up was limited to 26 of 41 patients. On physical examination, 3 patients had a separated anal sphincter. On ultrasound, overall 85%, of patients had intact sphincters, with no difference between groups (all P >.05). Forty-two percent of women complained of anorectal symptoms with no differences between groups (all P >.28). Conclusion: We found no difference in anal incontinence symptoms, physical examination, or translabial ultrasonography findings between the 2 groups. Incontinence symptoms were common in both groups. 2005 Elsevier Inc. All rights reserved.