A FUNCTIONAL AND SURGICAL OUTCOMES OF DELAYED EARLY VERSUS LATE REPAIR OF OBSTETRIC ANAL SPHINCTER INJURIES, A RETROSPECTIVE COHORT STUDY

Abstract

Background: Obstetric anal sphincter injuries (OASIS) remain a significant cause of postpartum anal incontinence and impaired quality of life among women. Standard management involves immediate primary repair; however, missed or inadequately repaired injuries often necessitate secondary reconstruction. Current practice varies between delayed-early repair (within 2–21 days after delivery) and late repair (≥3 months postpartum), yet evidence on comparative outcomes remains limited.

Objective: This study aims to compare functional outcomes (continence, quality of life) and surgical outcomes (wound complications, dehiscence, rupture, and fistula formation) between delayed-early and late anal sphincter repair in women with obstetric anal sphincter injuries.

Methods: This single-centre retrospective cohort study at Sahiwal Teaching Hospital (2014–2024) reviewed women undergoing delayed early and late anal sphincter repair by the same surgeon for ten year time period.  All patients received standardized postoperative care.

Results: Sixty women were analyzed (29 delayed early repair; 31 late repair). Mean blood loss, Wexner scores, postoperative pain, and quality-of-life measures (daily life interference, pad use, constipation medication, and urgency) were comparable between groups, with no statistically significant differences (p > 0.05). Both approaches achieved similar short-term clinical and functional outcomes.

Conclusion: our study suggests that both delayed early and late repairs can be effective and safe when performed by experienced surgeons with standardized postoperative protocols. Delayed early repair may offer the advantage of faster recovery and reduced risk of dyspareunia or fistula, though these trends require validation in larger studies