re isolated rectal buttonhole tears in obstetrics case series and review of the CORD-Papers-2022-06-02 (Version 1)

Title: Re: Isolated rectal buttonhole tears in obstetrics: case series and review of the literature
Published: 2021-01-06
Journal: Int Urogynecol J
DOI: 10.1007/s00192-020-04634-5
DOI_URL: http://doi.org/10.1007/s00192-020-04634-5
Author Name: Roper Joanna C
Author link: https://covid19-data.nist.gov/pid/rest/local/author/roper_joanna_c
Author Name: Thakar Ranee
Author link: https://covid19-data.nist.gov/pid/rest/local/author/thakar_ranee
Author Name: Sultan Abdul H
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sultan_abdul_h
sha: 4c0fde67004bce48cab1826c149906bd1338ded2
license: no-cc
license_url: [no creative commons license associated]
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 33404799
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/33404799
pmcid: PMC7786343
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786343
url: https://www.ncbi.nlm.nih.gov/pubmed/33404799/ https://doi.org/10.1007/s00192-020-04634-5
has_full_text: TRUE
Keywords Extracted from Text Content: whole-heartedly W e p l colorectal OASIS COVID-19 Habek m i rectal rectal mucosa anal sphincter third-or UK
Extracted Text Content in Record: First 5000 Characters:Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. We would like to thank Habek and Luetić for their letter regarding our paper [1] . We whole-heartedly agree that the diagnosis and repair of rectal buttonhole tears is complex and, given their rarity, many clinicians lack experience of and expertise in this condition. In the UK, undiagnosed rectal buttonhole tears are known to be a source of litigation, but most of these cases are settled out of court. It is also important that when such a tear is identified it is repaired by a senior, experienced obstetrician. We agree that the classification of obstetric anal sphincter injuries (OASIS) needs to be standardized and, since the introduction of the Sultan classification in 1999, it has now been incorporated in nearly all published national guidelines all over the world [2] . What our paper also adds is the recognition that a rectal buttonhole tear can occur in conjunction with a third-or fourth-degree tear, in the presence of an intact island of rectal mucosa. Indeed, the figure in your letter appears to also involve the anal sphincter. We appreciate the authors describing the two cases with poor outcomes that are undergoing litigation, as we have highlighted in our paper that such cases are not usually published. We recognized the deficiencies in training regarding the classification, diagnosis and repair of OASIS over 20 years ago and began the first hands-on course in 2000 (www. perineum.net). We have subsequently demonstrated the benefits of running such hands-on workshops [3] . Over the last 7 years we have introduced the Prevention and Repair of Perineal Trauma Episiotomy Through Coordinated Training (PROTECT) international "train the trainers" course and there are a multitude of international trainers certified by the International Urogynecological Association (www.IUGA. org). We are currently evaluating training in the UK through an online survey of doctors (obstetric and colorectal surgeons) and midwives in OASIS and perineal trauma. We are also appraising the teaching methods and content of the available training courses throughout the UK. During the current COVID-19 pandemic many hands-on courses were cancelled and some are now exploring new ways of delivering the content, to ensure that training opportunities are not m i s s e d ( w w w . p e r i n e u m . n e t ) . W e p l a n t o m a k e recommendations about the content and frequency of training, such as this, and to publish our data in the coming year. Finally, we would like to congratulate Habek and Luetić in recognizing the need to include this topic in their postgraduate training, and would suggest that they consider standardizing their training as per the PROTECT programme (www.IUGA.org).
Keywords Extracted from PMC Text: anal sphincter whole-heartedly rectal mucosa Habek UK rectal www.perineum.net OASIS colorectal COVID-19 "
Extracted PMC Text Content in Record: First 5000 Characters:Dear Editor, We would like to thank Habek and Luetić for their letter regarding our paper [1]. We whole-heartedly agree that the diagnosis and repair of rectal buttonhole tears is complex and, given their rarity, many clinicians lack experience of and expertise in this condition. In the UK, undiagnosed rectal buttonhole tears are known to be a source of litigation, but most of these cases are settled out of court. It is also important that when such a tear is identified it is repaired by a senior, experienced obstetrician. We agree that the classification of obstetric anal sphincter injuries (OASIS) needs to be standardized and, since the introduction of the Sultan classification in 1999, it has now been incorporated in nearly all published national guidelines all over the world [2]. What our paper also adds is the recognition that a rectal buttonhole tear can occur in conjunction with a third- or fourth-degree tear, in the presence of an intact island of rectal mucosa. Indeed, the figure in your letter appears to also involve the anal sphincter. We appreciate the authors describing the two cases with poor outcomes that are undergoing litigation, as we have highlighted in our paper that such cases are not usually published. We recognized the deficiencies in training regarding the classification, diagnosis and repair of OASIS over 20 years ago and began the first hands-on course in 2000 (www.perineum.net). We have subsequently demonstrated the benefits of running such hands-on workshops [3]. Over the last 7 years we have introduced the Prevention and Repair of Perineal Trauma Episiotomy Through Coordinated Training (PROTECT) international "train the trainers" course and there are a multitude of international trainers certified by the International Urogynecological Association (www.IUGA.org). We are currently evaluating training in the UK through an online survey of doctors (obstetric and colorectal surgeons) and midwives in OASIS and perineal trauma. We are also appraising the teaching methods and content of the available training courses throughout the UK. During the current COVID-19 pandemic many hands-on courses were cancelled and some are now exploring new ways of delivering the content, to ensure that training opportunities are not missed (www.perineum.net). We plan to make recommendations about the content and frequency of training, such as this, and to publish our data in the coming year. Finally, we would like to congratulate Habek and Luetić in recognizing the need to include this topic in their postgraduate training, and would suggest that they consider standardizing their training as per the PROTECT programme (www.IUGA.org).
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