None listed
Conditions
Brief summary
1-4% of women worldwide have vaginal deliveries which result in 3rd/4th degree perineal tears. A 3rd/4th degree tear means that the perineal tear extends through the anal sphincter and into the rectum. The result if unrepaired is faecal incontinence. Ideally if a woman suffers this injury during childbirth, the injury should be repaired immediately. In resource poor countries like Uganda, many women do not have access to obstetric care and thus these injuries are not repaired. This results in ongoing faecal incontinence. The investigators have been performing surgeries to repair these chronic 3rd/4th degree tears in Uganda since 2010. This is a follow-up audit of surgery performed. There is minimal published data on outcomes of repair of chronic 3rd/4th degree perineal tears. This project aims to follow-up women who have had this injury repaired by the investigating team, to assess for any ongoing anorectal symptoms eg faecal incontinence.
Interventions
Women attending surgical camps in Africa, with unrepaired 3rd and 4th degree perineal tears will be invited to participate in the follow up.
All women will have a routine history and examination, including a Cleveland Clinic anal continence score(collected prospectively).
All women who are fit for surgery will be offered surgery, performed under spinal anaesthesia. The repair is undertaken by mobilisation of the vaginal and anorectal tissues. The anorectal mucosa is closed in 2 layers using a de
Women attending surgical camps in Africa, with unrepaired 3rd and 4th degree perineal tears will be invited to participate in the follow up. All women will have a routine history and examination, including a Cleveland Clinic anal continence score(collected prospectively). All women who are fit for surgery will be offered surgery, performed under spinal anaesthesia. The repair is undertaken by mobilisation of the vaginal and anorectal tissues. The anorectal mucosa is closed in 2 layers using a delayed absorbable suture, then an over-lapping external anal sphincter repair is undertaken. The perineal body is reconstructed and vaginal epithelium and perineal body skin closed. An indwelling bladder catheter and vaginal are inserted and both are removed day 2 post-operatively. Routine post-operative observations and analgesics are given. After discharge from hospital, women consenting to follow up will be contacted by telephone by the local nurse, speaking in the local language. The Cleveland Clinic score is documented at 6-12 weeks following surgery, and at yearly intervals for a period of 5-years. The local nurse contacts the women at those time intervals to prospectively collect the score.
Sponsors
Judith Goh
Eligibility
Sex/Gender
All
Age
12 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
Women attending surgical camps with unreported 3rd or 4th degree perineal tears
Exclusion criteria
Women who decline follow-up after surgery
Outcome results
None listed