A Modified Surgical Approach to Women With Obstetric Anal Sphincter Tears

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01021722
Recruitment Status : Completed
First Posted : November 30, 2009
Last Update Posted : November 30, 2009
Lund University
Region Skane
Information provided by:
Karolinska University Hospital

Brief Summary:

Long-term results after obstetric anal sphincter tears (AST) is poor. The investigators aim to improve the long-term outcome after AST in terms of symptoms of anal incontinence.

A prospective study at, Malmö University Hospital. Twenty-six women with at least grade 3B AST were classified and sutured in a systematic way, including separate suturing of the internal and external sphincter muscles with monofilament absorbable sutures. The principal outcome was a difference in anal incontinence score, based on six questions, between the study group and two control groups (women with prior AST [n = 180] and primiparous women delivered vaginally without AST [n = 100]).

Condition or disease Intervention/treatment Phase
Obstetric Surgical Procedures Procedure: modified suture technique Phase 4

Detailed Description:

The series was undertaken in advance of a planned prospective randomized controlled study. The study was approved by the Research Ethics Committee of Lund University and informed consent was obtained from all the women involved. Twenty-six women presenting with at least a 3B rupture were recruited by one of the two surgeons (MJ, PL). The modified technique included:

  1. Adoption of a structured way of describing the damage according to Fornell an co-workers[7] and recommended by RCOG.[8] Grade 3A: any tear of the ESM < 50% Grade 3B: an ESM tear > 50% Grade 3C: related damage to the ISM Grade 4: related rupture of the anal mucosa
  2. The use of monofilament resorbable suture material for all sutures in the mucosa or sphincter muscles. The anal mucosa was sutured with a continuous layer of 3.0 glycomer 631 (Biosyn® ,Tyco Healthcare, Mansfield, MA, USA); the ISM with a continuous layer of 3.0 glycomer 631; and the ESM (both superficial and profound portions) with interrupted end-to-end 2.0 glycomer 631 sutures. The perineal body was usually sutured with 2.0 or 3.0 lactomer (Polysorb®, Tyco Healthcare, Mansfield, MA, USA).
  3. Metronidazole 1.5g as a single IV injection and/or Cefuroxime 1.5g IV during the procedure and 6 hours post-operative was usually given as prophylaxis.
  4. All women were sutured under either regional anaesthesia (spinal, epidural, or pudendal) or general anaesthesia. Thus, the modified procedure included both a new technique of suturing and the operation was performed by one of the two surgeons involved in the study. Apart from this, all women were treated according to routine departmental practice.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 239 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Modified Surgical Approach to Women With Obstetric Anal Sphincter Tears
Study Start Date : November 2002
Actual Primary Completion Date : August 2005
Actual Study Completion Date : August 2005

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Tears

Arm Intervention/treatment
Experimental: Modified suture technique
Sutured in a modified manner
Procedure: modified suture technique
Both internal and external anal sphincter was sutured separately end to end
Other Names:
  • Historical sphincter tears
  • Historical normal deliveries

No Intervention: Historical sphincter group
The outcome of historical sphincter tears
No Intervention: Normal primaparous deliveries
Normal deliveries

Primary Outcome Measures :
  1. Differences in anal incontinence score between a study group and two control groups [ Time Frame: 1 year ]

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Sphincter tear > grad 3B

Exclusion Criteria:

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01021722

Malmö, Sweden, 20502
Sponsors and Collaborators
Karolinska University Hospital
Lund University
Region Skane
Principal Investigator: Pelle G Lindqvist KarolinskaUniversity Hospital

Responsible Party: Pelle Lindqvist, Karolinska University Hospital Identifier: NCT01021722     History of Changes
Other Study ID Numbers: sphincter2009
First Posted: November 30, 2009    Key Record Dates
Last Update Posted: November 30, 2009
Last Verified: November 2009

Keywords provided by Karolinska University Hospital:
obstetric tears
long-term follow-up