Fourth degree perineal tears: surgical repair technique in 10 steps - 19/04/21

Doi : 10.1016/j.jogoh.2021.102151

G. Lamblin ^a,^b,^⁎ , M. de Boisredon ^a,^b,^{^{1
Names of co-authors:}}, L. Picard ^a,^b,^{^{1
Names of co-authors:}}, A. Atallah ^a,^b,^{^{1
Names of co-authors:}}, J. Massardier ^a,^b,^{^{1
Names of co-authors:}}, G. Chene ^a,^b,^{^{1
Names of co-authors:}}, E. Nohuz ^a,^b,^{^{1
Names of co-authors:}}
^a Department of Gynecology and Obstetrics, Femme Mère Enfant University Hospital, 59 Boulevard Pinel, 69677 Lyon-Bron, France.
^b Claude Bernard University Lyon 1, avenue Rockfeller, 69008 Lyon

^⁎Corresponding Author: Department of Gynecology, Femme Mère Enfant University Hospital, 59 Boulevard Pinel, 69677 Lyon-Bron, France. Telephone number: + 33-4-72-35-58-86 / +33-6-61-58-21-93. Fax number: +33-4-27-86-92-67. All authors saw and approved the final versionDepartment of GynecologyFemme Mère Enfant University Hospital59 Boulevard PinelLyon-Bron69677France

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Abstract

Obstetrical anal sphincter injury (OASIS) may lead to significant comorbidities, including anal incontinence, rectovaginal fistula, and pain. A correct repair is required to avoid improper healing, as a persistent defect in the external anal sphincter after delivery can increase the risk of complications and worsening of symptoms following subsequent vaginal deliveries. Herein is described the surgical repair technique for a fourth degree perineal tear. Regarding resident education, there are challenges associated with the proper training in OASIS repair. The procedure is illustrated by an instructive video article that standardizes the essential steps to make the technique ergonomic and easy to perform with step-by-step explanations.

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Keywords : fourth degree perineal tears, obstetrical anal sphincter injury (OASIS), vaginal birth, anal sphincter, postpartum urinary retention