Modern technique of sphincter repair after obstetric perineal trauma.

Obstetric anal sphincter injuries (OASIS) complicate up to 11% of vaginal deliveries. Major risk factors for obstetric anal sphincter injuries (OASIS) are episiotomy (OR, 1.74; 95% CI, 1.28-2.38) and instrumental deliveries. Anal sphincter defects which are often followed by incontinence, and undoubtedly cause a significant decrease in quality of life, sometimes with a dramatic impact on a women's social relationships. It also causes psychological symptoms such as anxiety and depression. In the European guidelines there is no consensus on the optimal management of OASIS [1]. Some questions remain. Is the sphincter repair the responsibility of obstetricians or proctologists? What is the optimal timing of a secondary repair? How to choose the right treatment approach between surgical repair (sphincteroplasty) and minimally invasive techniques (sacral nerve stimulation)? What type of suture technique (overlapping or end-to-end) is better? Should anal sphincters be repaired separately or en-bloc? Is it necessary to preserve scar tissue on mobilized sphincter edges? Should preoperative antibiotics be used? What postoperative bowel regimen is best? Is there a need for a diverting stoma? In this video we demonstrate a modern technique of secondary sphincter repair with preservation of the distal branches of the anal nerves. This has promising results in restoring continence and improving quality of life.