Management of obstetrical injuries to the anal sphincter: A survey of French current practice and perceptions according to the specialties - 12/01/21

Doi : 10.1016/j.jviscsurg.2020.10.006

A. Venara ^a,^b,^c,^d,^e,^f,⁎ , C. Brochard ^b,^c,^g, X. Fritel ^h,ⁱ, V. Bridoux ^d,^j, L. Abramowitz ^a,^b,^k,^l, G. Legendre ^h,^m, L. Siproudhis ^b,^c,^f
^a Service de chirurgie viscérale et endocrinienne, CHU d’Angers, 4, rue Larrey, 49933 Angers cedex 9, France
^b Société nationale française de coloproctologie (SNFCP), France
^c Groupe de recherche en proctologie (GREP), France
^d Association française de chirurgie (AFC), France
^e Faculté de santé, département de médecine, université Angers, 49045 Angers cedex 01, France
^f Laboratoire IHFIH, UPRES EA 3859, France
^g Service des maladies de l’appareil digestif, unité de proctologie, CHU Rennes Pontchaillou, 35000 Rennes, France
^h Collège national des obstétriciens et gynécologues français (CNGOF), France
ⁱ Université de Poitiers–CHU de Poitiers, service de gynécologie-obstétrique et médecine de la reproduction, 86021 Poitiers, France
^j Service de chirurgie viscérale et endocrinienne, CHU de Rouen, 76000 Rouen, France
^k Service d’hépato-gastroentérologie et proctologie, hôpital Bichat-Claude Bernard, 75018 Paris, France
^l Ramsay général de santé, clinique Blomet, 75015 Paris, France
^m Service de gynécologie obstétrique, CHU d’Angers, 49933 Angers cedex 9, France

^⁎Corresponding author at: Service de chirurgie viscérale et endocrinienne, 4, rue Larrey, 49933 Angers cedex 9, France.Service de chirurgie viscérale et endocrinienne4, rue LarreyAngers cedex 949933France

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Tuesday 12 January 2021
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Summary

Aim of the study

To conduct a survey of current practice in the management of obstetrical anal sphincter injuries (OASI) and to compare short, medium and long-term practices according to the specialty of the surgeon.

Patients and methods

A 50-item questionnaire was addressed by mail to various specialists via the national learned societies. The questionnaire was addressed only to practitioners who currently managed OASI in their practice.

Results

Of the 135 healthcare professionals who responded, 57 were sub-specialists in ano-rectal surgery (42.2%) and 78 were obstetrical or gynecological specialists (OB-GYN) (57.8%). Management in the acute period after OASI was similar among the specialties and 50% of the practitioners did not perform suture repair of the internal sphincter. Furthermore, few gynecological specialists recommended systematic consultation with an ano-rectal specialist during acute management. In the medium term, ano-rectal specialists were more likely to explore gastro-intestinal symptoms, either clinically or through para-clinical studies. However, these studies did not systematically lead to interventional management in the absence of consensus, particularly for medium-term sphincter repair. In addition, 25% of practitioners recommended that patients undergo systematic delivery by caesarean section for further pregnancies after OASI. In the long term (>12 months), there were substantial differences in management of OASI not only between specialties but also within the same specialty.