Immediate or delayed repair of obstetric anal sphincter tears: a randomised controlled trial

Objective  To investigate if an 8- to 12-hour time delay of primary repair affects anal incontinence at 1-year follow up. Design  Randomised controlled trial. Setting  University hospital in Sweden. Population  A total of 165 women diagnosed with a third- to fourth-degree perineal tear. Methods  The participants were randomised to immediate or delayed (8- to 12-hour delay) end-to-end repair; 78 were allocated to immediate operation and 87 to a delayed repair. An incontinence and pelvic floor symptom questionnaire was completed by the participants at baseline and at 6- and 12-month follow up. Main outcome measures  Anal incontinence measured by the validated Pescatori incontinence score. Results  A total of 161 (98%) and 155 (94%) women completed the two follow-up questionnaires. There was no significant difference in anal incontinence between the groups. There were no significant differences in pelvic floor symptoms between the groups. A multivariate proportional odds model revealed that increasing maternal age was significantly associated with both increased symptoms of faecal urgency and inability to discriminate flatus from faeces. Conclusion  Delayed repair provided the same functional outcome at 1-year follow up. Delaying the repair should thus not be recommended routinely, but can be an alternative under special circumstances when appropriate surgical expertise is not readily available.