Suffizienz der End-zu-Endanastomose bei primärer Versorgung eines geburtstraumatischen Analsphinkterrisses

Zusammenfassung

Fragestellung: Beurteilung der Qualität einer End-zu-Endanastomose bei der Primärversorgung geburtshilflich bedingter Analsphinkterrisse. Patientinnen und Methode: 49 Frauen mit Dammriss III. Grades (DR III) sowie eine Kontrollgruppe von 42 Frauen wurden im Verlauf von 3 Jahren postpartum (pp) nachuntersucht. Ergebnisse: Die Primärversorgung durch End-zu-Endanastomose war sonographisch bei 22 (52,4 %) der Frauen insuffizient. 31 (63,2 %) Frauen entwickelten eine Analinkontinenz. Schlussfolgerungen: Die sonomorphologischen Ergebnisse nach End-zu-Endanastomose in dieser Studie sind unbefriedigend. In Anbetracht der hohen Zahl analinkontinenter Frauen nach DR III sollte die Prävention in den Vordergrund gestellt werden, das Benefit eines Second repair zu späterem Zeitpunkt ist zu diskutieren.

Abstract

Purpose: To assess the quality of end-to-end anastomosis in the primary repair of anal sphincter laceration occurring during delivery. Methods: Forty-nine women with third degree perineal laceration (PL III) and 42 controls were included in a 3-year postpartal follow-up study. Results: Ultrasound showed end-to-end anastomosis to be inadequate in 22 (48.1 %) women. Thirty-one (63.2 %) women developed grade I-III anal incontinence. Discussion: There was no correlation between ultrasound findings and the presence of anal incontinence. The unsatisfactory sonomorphometric outcome after 6 weeks results from inadequate repair with retraction of the sphincter ends. Defects newly demonstrated after 36 months indicate dedifferentiating atrophy with damage to peripheral motor nerves.

Geburtshilfliche Sphinkterrisse - End-zu-End-Anastomose - Analinkontinenz - Endoanale Sonographie

Obstetric anal sphincter laceration - end-to-end anastomosis - anal incontinence - endoanal ultrasonography

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