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Comment and Controversy

Restore perineal anatomy in episiotomy repair

January 2004 · Vol. 16, No. 1
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To the Editor:

Trained to do episiotomies in the 1970s, I was resistant to the idea of avoiding them for fear of difficult-to-repair lacerations and pelvic floor dysfunction. Since becoming involved in resident education, however, I have become convinced that they should be avoided if possible.

Still, I am disturbed by 2 things: One is that I have seen residents graduate without ever repairing a fourth-degree laceration. The other is the way in which episiotomy repair is performed and taught. For many clinicians, it seems the goal is to repair the incision as fast as possible and, if feasible, with just 1 continuous suture. Little thought is given to restoring the anatomy of the perineal body.

Dr. Repke’s article presents a good review, but it seems there is a paucity of evidence comparing repair techniques. Just as we repair rectus fascia on abdominal incisions if we want to prevent incisional hernias, I believe we must properly restore the pelvic floor anatomy and not just put “stuff” together as quickly as we can.


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