Advantages of a posterior fourchette incision in anal sphincter repair

PURPOSE: Delayed repair of obstetric-related anal sphincter injury remains problematic, and perineal wound breakdown is common. The aim of this study was to assess the outcome after overlap anal sphincter repair and to determ ine the advantages, if any, of a posterior fourchette incision (n = 18) com pared with a conventional perineal incision (n = 32). METHODS: Fifty female s of mean parity 2.8 (standard deviation, 1.6) underwent repair in a five-y ear period. The mean follow-up was 23 months. Assessment was by anal vector manometry, endoanal ultrasound, and continence scoring. RESULTS: Functiona l outcomes were sin-War in the two groups. Repair increased squeeze-pressur e increment and improved continence scores in both groups. Postoperative wo und complications were fewer when a posterior fourchette incision was used compared with a perineal incision (11 vs. 44 percent, respectively; P < 0.0 5). CONCLUSIONS: Delayed anal sphincter repair improves continence. A poste rior fourchette approach is associated with fewer postoperative wound compl ications without compromising the quality of repair and the functional outc ome.