Purpose/Background: Obstetrical anal sphincter injury (OASI) should be repaired surgically as early as possible after vaginal delivery. In cases of functional failure and persistent fecal incontinence following primary sphincteroplasty, it remains unclear whether secondary sphincter repair is a safe and effective therapeutic option. We present a clinical case to address this question
Methods/Interventions: A 33-year-old woman underwent instrumental vaginal delivery (forceps) of a 3730 g infant. A grade 3 OASI was diagnosed, and immediate primary sphincter repair was performed. Despite perineal physiotherapy, she reported fecal incontinence and perineal deformity two months later. She was referred to our colorectal unit. Her Cleveland Clinic Fecal Incontinence (CCFI) score was 18. Digital rectal examination revealed an anterior external anal sphincter (EAS) defect. Endoanal ultrasound showed a 30% EAS defect from the 9 to 12 o’clock position. After multidisciplinary discussion and informed consent, a secondary sphincteroplasty using the overlap technique was performed following mechanical bowel preparation, without diverting stoma
Results/Outcomes: Postoperative recovery was uneventful. The patient was discharged after 6 days and was continent to gas and stool. Her CCFI score decreased to 3 at 1 week, 1 month and 3 months. At 12-month follow-up, she remained continent (CCFI = 4), with no perineal deformity and no impact on social or sexual life
Conclusion/Discussion: In cases of persistent fecal incontinence after primary sphincteroplasty for OASI, secondary sphincter repair can be safely performed without diversion stoma, providing rapid and satisfactory functional results as well as correction of perineal deformity. Ongoing follow-up is required to assess long-term outcomes.
