A UK wide survey of general surgeons' experience of the primary repair of obstetric anal sphincter injuries
Author(s)
Elsaid, Nada
Thomas, Gregory P
Carrington, Emma V
Fernando, Ruwan J
Vaizey, Carolynne J
Type
Journal Article
Abstract
Aim
Obstetric anal sphincter injuries (OASIs) are associated with devastating consequences, mainly faecal incontinence. A timely and correct repair is necessary to reduce the risk of maternal morbidity. The aim was to explore the experience and practice of on-call general surgeons in the acute repair of OASIs.
Method
A cross-sectional, observational questionnaire study was performed. Registrars and consultants participating in an emergency general surgical rota in the UK were included. A 33-item questionnaire was disseminated over a 9-month period from April 2023. A descriptive, thematic analysis of the data was undertaken.
Results
In all, 310 responses were analysed. 42.3% of colorectal respondents (of which 29% were pelvic floor specialists), 24.3% of general surgeons, 16.7% of hepato-biliary surgeons and 13.7% of upper gastrointestinal surgeons were contacted to assist with an acute repair. Of those contacted, 52.3% typically assisted with a 3C or 4 tear, 54.2% received no training and 95.5% performed less than three acute repairs in the previous year. 57.6% of all respondents were not confident at all in the repair of these injuries, 55% highlighted a lack of experience and 36% mentioned a curricular gap.
Conclusion
Surgeons may be called to assist with an acute OASI repair, particularly in cases of severe anatomical disruption. This occurs infrequently. There is a lack of consensus as to who is responsible for these injuries. Obstetricians have structured training in both the recognition and repair of these injuries. This paper serves to highlight the lack of training for surgeons who report doing this surgery despite lacking the required competences.
Obstetric anal sphincter injuries (OASIs) are associated with devastating consequences, mainly faecal incontinence. A timely and correct repair is necessary to reduce the risk of maternal morbidity. The aim was to explore the experience and practice of on-call general surgeons in the acute repair of OASIs.
Method
A cross-sectional, observational questionnaire study was performed. Registrars and consultants participating in an emergency general surgical rota in the UK were included. A 33-item questionnaire was disseminated over a 9-month period from April 2023. A descriptive, thematic analysis of the data was undertaken.
Results
In all, 310 responses were analysed. 42.3% of colorectal respondents (of which 29% were pelvic floor specialists), 24.3% of general surgeons, 16.7% of hepato-biliary surgeons and 13.7% of upper gastrointestinal surgeons were contacted to assist with an acute repair. Of those contacted, 52.3% typically assisted with a 3C or 4 tear, 54.2% received no training and 95.5% performed less than three acute repairs in the previous year. 57.6% of all respondents were not confident at all in the repair of these injuries, 55% highlighted a lack of experience and 36% mentioned a curricular gap.
Conclusion
Surgeons may be called to assist with an acute OASI repair, particularly in cases of severe anatomical disruption. This occurs infrequently. There is a lack of consensus as to who is responsible for these injuries. Obstetricians have structured training in both the recognition and repair of these injuries. This paper serves to highlight the lack of training for surgeons who report doing this surgery despite lacking the required competences.
Date Issued
2025-01-01
Date Acceptance
2024-10-22
Citation
Colorectal Disease, 2025, 27 (1)
ISSN
1462-8910
Publisher
Wiley
Journal / Book Title
Colorectal Disease
Volume
27
Issue
1
Copyright Statement
© 2024 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39567247
Subjects
3RD
anal sphincter
CONSEQUENCES
faecal incontinence
Gastroenterology & Hepatology
Life Sciences & Biomedicine
MANAGEMENT
OASIS
obstetric anal sphincter injury
primary sphincter repair
Science & Technology
SECONDARY
Surgery
TEARS
VAGINAL DELIVERY
Publication Status
Published
Coverage Spatial
England
Article Number
e17244
Date Publish Online
2024-11-20