OBSTETRİK ANAL SFİNKTER YARALANMASI OLAN HASTALARDA RİSK FAKTÖRLERİ, CERRAHİ ONARIM TEKNİKLERİ VE POSTOPERATİF SONUÇLARIN DEĞERLENDİRİLMESİ: RETROSPEKTİF GÖZLEMSEL BİR ÇALIŞMA

Yıl 2025, Cilt: 5 Sayı: 14, 204 - 210, 29.10.2025

Emrah Dağdeviren , Can Tercan , Ali Selçuk Yeniocak , Hakan Kırıt , Cafer Yelkenci , Turan Arda Demirağ , Yıldız Karademir

https://doi.org/10.54270/atljm.2025.101

Öz

Özet
Amaç:
Bu çalışmanın amacı, üçüncü ve dördüncü derece obstetrik anal sfinkter yaralanmalarının (OASIS) risk faktörlerini, cerrahi onarım tekniklerini ve postoperatif sonuçlarını değerlendirmektir.
Gereç ve Yöntemler:
Bu retrospektif gözlemsel çalışma, üçüncü veya dördüncü derece perineal yırtığı nedeniyle primer sfinkteroplasti yapılan 29 hastayı kapsamaktadır. Klinik veriler, elektronik hasta kayıtları ve ameliyat notlarından elde edilmiştir. Perineal yırtık derecesi, uygulanan onarım tekniği (uç uca veya üst üste), sütür materyali ve postoperatif semptomlar analiz edilmiştir. Fonksiyonel sonuçlar Wexner fekal inkontinans skoru ile değerlendirilmiştir.
Bulgular:
Hastaların çoğu primipardı ve ortalama doğum yaşı 25.6 yıl idi. En yaygın yırtık tipi %48.3 ile 3B idi. Onarımların %69’unda uç uca teknik kullanıldı; en sık tercih edilen sütür materyali ise Vicryl oldu. Wexner skorları mevcut olan 9 hastanın 3’ünde fekal inkontinans bulunmazken, 2 hastada skor 8 olarak kaydedildi. Onarımların çoğu kadın doğum uzmanları tarafından gerçekleştirildi.
Sonuç:
OASIS yönetiminde bireyselleştirilmiş, anatomik olarak doğru ve teknik olarak dikkatli cerrahi onarım esastır. Uygun teknik seçimi ve katmanlı kapama prensiplerine uyum, kontinensin korunmasına katkı sağlayabilir. Ancak daha geniş örneklemli, uzun dönem takipli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

fekal inkontinans , perineal laserasyon , sfinkter onarımı , wexner skorlaması

EVALUATION OF RISK FACTORS, SURGICAL REPAIR TECHNIQUES, AND POSTOPERATIVE OUTCOMES IN PATIENTS WITH OBSTETRIC ANAL SPHINCTER INJURY: A RETROSPECTIVE OBSERVATIONAL STUDY

Öz

Abstract
Aim:
This study aims to evaluate the risk factors, surgical repair techniques, and postoperative outcomes of third- and fourth-degree obstetric anal sphincter injuries (OASIS).
Materials and Methods:
This retrospective observational study included 29 patients who underwent primary sphincteroplasty for OASIS. Data were collected from hospital electronic records and operative reports. Variables such as degree of laceration, repair technique (end-to-end or overlapping), suture material, and postoperative complications were analyzed. Functional outcomes were assessed using the Wexner fecal incontinence score when available.
Results:
Most patients were primiparous, with a mean maternal age of 25.6 years. Type 3B tears were the most common (48.3%). The end-to-end technique was used in 69% of cases, and Vicryl was the most commonly used suture material. Among the 9 patients with available Wexner scores, 3 reported no fecal incontinence, while 2 had a score of 8. The majority of repairs were performed by obstetricians.
Conclusion:
Individualized, anatomically precise, and technically meticulous repair is essential in OASIS management. Adherence to principles such as layered closure and appropriate technique selection may enhance continence outcomes. However, larger, long-term studies are needed to confirm these findings and optimize care strategies.

Anahtar Kelimeler

fecal incontinence , perineal laceration , sphincter repair , Wexner scoring

Kaynakça

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