Abstract
ABSTRACT
The objective of this study was to report our experiences using the layered closure technique for obstetric-related old complete perineal lacerations. This was a retrospective study that identified all patients who underwent surgical correction for a defect that was obstetric-related and involved complete or near complete disruption of the perineal body and external anal sphincter. Thirty-one patients were included for analysis. Two patients each had undergone one prior attempt at repair. The mean interval from the time of laceration or previous repair to the repair was 26 months, with a range of 8 days to 15 years. Five patients underwent repair at the time of a subsequent vaginal delivery. Two patients underwent early repair for what was essentially a dehiscence of a fourth-degree episiotomy. Twenty-six of the 31 patients (84%) healed uneventfully and remained completely continent. The remaining 5 patients had some element of breakdown of the repair. Factors that may have contributed to failure in these 5 patients are discussed. Two patients underwent one subsequent spontaneous vaginal delivery, and 1 patient underwent two subsequent spontaneous vaginal deliveries, none of these with recurrence of the problem. Four patients underwent subsequent cesarean section. The layered repair technique is efficacious for the treatment of obstetric-related old complete perineal lacerations. Several controversies that exist about the management of the patients discussed. (J GYNECOL SURG 8:171, 1992)
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