How to Avoid Becoming a Risk Factor of Fecal Incontinence Due to OASIS—A Narrative Review
Abstract
:1. Introduction
2. Materials, Methods, and Research Questions
- Recurrent OASIS;
- Pitfalls of the current WHO classification;
- Surgical technique and muscles to be repaired;
- Where to repair perineal lacerations of grade III-IV;
- Surgical training;
- Low patient volumes;
- Delayed primary repair;
- Failure of primary repair.
3. Recurrent OASIS
- Those patients who, after third- and fourth-degree perineal injuries, decide on natural childbirth should—after documenting—give birth in hospitals where doctors are readily available who actually and practically deal with perineal injuries around the clock and ensure continuity of proctological supervision and comprehensive counseling and treatment after these injuries.
- When during the subsequent delivery, incorrect information is provided to the patient about the possible consequences of another natural childbirth;
- When a patient with a history of perineal laceration decides on natural childbirth and there is a lack of a specialist who deals with the surgical treatment of perineal injuries, including care for the patient after this repair; this note concerns patients who have already undergone anal sphincter damage where repairs are technically very demanding.
4. Pitfalls of the Current WHO Classification
5. Surgical Technique and Muscles to Be Repaired
6. Where to Repair Perineal Lacerations of Grade III–IV?
7. Repair of Perineal Lacerations: Training vs. Reality
8. Low Volume of Patients
9. Delayed Primary Repairs
10. Failure of Primary Repair
11. Conclusions
- Patients with a history of grade III–IV perineal damage should be informed about the potential for recurrent perineal tearing during vaginal childbirth, and we should offer them the option of completing the pregnancy via cesarean section.
- We should remember that the Sultan scale (the current WHO scale) does not reflect all muscles involved in continence; this refers to the levator ani muscle (LAM).
- The EAS should be repaired in a manner that ensures its full length will be restored. In cases of severe perineal injury, the LAM should always be assessed and repaired if injured.
- OASIS of grade III and higher should be repaired in the operation theatre to provide the best conditions both for the examination of the OASI and for the repair itself.
- In case we previously have only repaired perineal lacerations III–IV on animal models, we should ask someone experienced to at least supervise the repair.
- In case of small patient volumes, lack of resources, or postop supervision, referring the patient to a suitable center should be considered.
- When perineal laceration III–IV occurs and no experienced surgeon is available, the repair can be delayed up to 12 h. Within these 12 h, the repair should be performed by the attending surgeon or at a specialized center after transferring the patient.
- Patients with failure of primary repair should be offered an option of having the early secondary repair that can be performed even 21 days post-partum. Due to known complications, failures of primary repairs should be managed in specialized centers that can provide full postoperative patient supervision and care.
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Horst, N. How to Avoid Becoming a Risk Factor of Fecal Incontinence Due to OASIS—A Narrative Review. J. Clin. Med. 2024, 13, 5071. https://doi.org/10.3390/jcm13175071
Horst N. How to Avoid Becoming a Risk Factor of Fecal Incontinence Due to OASIS—A Narrative Review. Journal of Clinical Medicine. 2024; 13(17):5071. https://doi.org/10.3390/jcm13175071
Chicago/Turabian StyleHorst, Nikodem. 2024. "How to Avoid Becoming a Risk Factor of Fecal Incontinence Due to OASIS—A Narrative Review" Journal of Clinical Medicine 13, no. 17: 5071. https://doi.org/10.3390/jcm13175071