How to Avoid Becoming a Risk Factor of Fecal Incontinence Due to OASIS—A Narrative Review

TL;DR

This review discusses avoidable risk factors for failed OASIS repair during childbirth, focusing on surgeon-related issues and techniques to prevent fecal incontinence.

Contribution

The paper introduces new perspectives on avoidable risk factors for OASIS repair failure, emphasizing surgeon and procedural factors.

Findings

Avoidable risk factors include surgeon training and surgical techniques.

Recurrent OASIS and WHO classification pitfalls contribute to repair failure.

Primary repair failure is linked to low patient volume and timing of the procedure.

Abstract

Third- and fourth-degree anal sphincter injuries are among the most severe traumas women can experience during childbirth, often leading to lifelong continence issues. Despite extensive research, current repair techniques are often inadequate, failing to provide long-term efficiency. The repair of OASIS tends to worsen with time as fecal or anal incontinence increases. This article presents the risk factors for primary repair failure differently from those previously described in the literature, specifically focusing on avoidable risk factors related to obstetricians and surgeons who perform OASIS repair. After reviewing the literature, the following risk areas were identified and described: recurrent OASIS, pitfalls of the current WHO classification, surgical techniques, place in which the repair should be performed, surgical training, factors related to low volumes of patients with grade III-IV injuries, timing of the repair, and failure of primary repair.