Question

How will you repair a complete perineal tear?

Hint:

Careful and precise suturing is critical in the repair of a complete perineal tear to restore function and minimize long-term complications.

Answer 1

Step 1: Understanding a Complete Perineal Tear.
A complete perineal tear, also called a third-degree or fourth-degree tear, involves not only the vaginal mucosa but also the perineal muscles and possibly the anal sphincter complex. This type of tear requires surgical repair immediately after delivery.

Step 2: Steps for Repair.
1. **Anaesthesia:** Ensure adequate local or regional anaesthesia to minimize discomfort during repair.
2. **Examine the Tear:** Carefully assess the tear to determine the extent and involvement of the anal sphincter.
3. **Vaginal Mucosa Repair:** Begin by suturing the vaginal mucosa, using absorbable sutures, and ensuring good tissue alignment.
4. **Perineal Muscles and Fascia Repair:** Repair the perineal muscles and fascia with interrupted absorbable sutures, ensuring good tissue approximation and preventing gaps.
5. **Anal Sphincter Repair (if involved):** If the anal sphincter is torn (third or fourth degree), it must be carefully repaired with absorbable sutures in multiple layers to restore function and prevent incontinence.

Step 3: Postoperative Care.
Post-surgical care involves ensuring good perineal hygiene, managing pain, and monitoring for signs of infection or complications such as anal incontinence. Follow-up examinations are necessary to check for healing and recovery of anal sphincter function.

Step 4: Conclusion.
Repairing a complete perineal tear requires skillful suturing, especially of the anal sphincter, and must be done promptly to ensure optimal recovery and avoid complications.