Лучшие больницы для «Episiotomy Repair» в Ченнаи, Индия

The perineum — the fibromuscular tissue between the vaginal introitus and the anal verge — is the principal load-bearing structure of the pelvic floor during vaginal delivery. Perineal tears are classified by the Royal College of Obstetricians and Gynaecologists (RCOG) and the International Urogynecological Association (IUGA) into four degrees: first-degree (fourchette skin only), second-degree (involving the perineal muscles but sparing the anal sphincter), third-degree (partial or complete external anal sphincter — EAS — disruption, subdivided 3a, 3b, 3c), and fourth-degree (complete EAS and internal anal sphincter — IAS — disruption with rectal mucosal involvement). An episiotomy is a deliberately placed surgical incision — mediolateral (angled 45–60° from the midline, preferred in evidence-based practice) or midline — intended to enlarge the vaginal outlet. When inadequately repaired, these injuries result in pelvic floor dysfunction, stress or urge urinary incontinence, faecal urgency or incontinence, chronic perineal pain, sexual dysfunction, and rectovaginal fistula.

• Women with Grade 3 or Grade 4 perineal tears (OASIS — Obstetric Anal Sphincter Injuries) identified at delivery or detected postpartum via endoanal ultrasound showing a sphincter defect >30° arc
• Patients with symptomatic episiotomy dehiscence (wound breakdown), chronic episiotomy scar pain (granuloma, neuroma, or keloid), or episiotomy scar dyspareunia unresponsive to conservative management
• Women with secondary perineal defects: failed primary OASIS repair confirmed by persistent faecal urgency or incontinence (St. Mark's Incontinence Score ≥10), with EAUS showing residual sphincter gap >1 cm
• Patients with rectovaginal fistula (low or mid-vaginal) of obstetric origin, presenting with passage of flatus or stool per vaginum
• Women with perineal body deficiency causing posterior vaginal wall prolapse (rectocele or enterocele) requiring concurrent perineorrhaphy
• +2 more

PRIMARY EPISIOTOMY AND PERINEAL TEAR REPAIR (ACUTE SETTING) First- and second-degree tears: Continuous, unlocked Polyglactin 910 (Vicryl Rapide 2-0) suture repair of the vaginal epithelium with a single suture carried through the perineal muscle layer and skin, using the RCOG-recommended 'continuous non-locking' technique shown in the SUNS trial to reduce short-term pain compared to interrupted sutures. Local infiltration with 0.5% bupivacaine + 1:200,000 adrenaline is standard for intraoperative haemostasis and postoperative analgesia.

Third-degree tears (OASIS): Two techniques are validated: (1) End-to-end (approximation) repair — the torn EAS ends are apposed without overlap, using interrupted figure-of-eight PDS (Polydioxanone) 2-0 sutures; (2) Overlap repair — the EAS stumps are overlapped by 1–1.5 cm and secured with horizontal mattress sutures (preferred for complete EAS disruption, 3b/3c). The IAS, when identified, is repaired separately with interrupted PDS 3-0 sutures. All OASIS repairs are performed in theatre under regional (spinal) or general anaesthesia with a trained colorectal or urogynaecological surgeon.

Fourth-degree tears: Additional repair of the rectal mucosa with interrupted, inversion sutures of Polyglactin 2-0 (mucosal layer) before sphincter reconstruction. Broad-spectrum antibiotic prophylaxis (cefuroxime + metronidazole) is mandatory. A stool softener regimen (lactulose + macrogol) is initiated postoperatively for 10–14 days to prevent straining.

SECONDARY PERINEAL REPAIR (ELECTIVE/DELAYED) Sphincter Overlap Repair (Overlapping Sphincteroplasty): The gold-standard secondary procedure for faecal incontinence due to EAS defect. A curved perineal incision is made, the EAS scar tissue is mobilised, and the muscle ends are overlapped by 1.5–2 cm and secured with two rows of horizontal mattress PDS sutures. Success rates (continence restoration) range 50–75% at 5 years, declining with age and pudendal neuropathy.

PHASE 1 — PRE-TRAVEL CONSULTATION (2–4 WEEKS BEFORE ARRIVAL) Step 1: Submit medical records to GAF Healthcare — discharge summaries, operative notes (if prior repair), EAUS images, anorectal manometry reports, pelvic MRI, urodynamic study reports, and current medications. GAF's coordinating urogynaecologist reviews records within 48 hours and provides a treatment plan, cost estimate, and hospital recommendation. Step 2: Virtual pre-operative consultation with the operating surgeon in India or UAE via secure telemedicine. Surgeon reviews imaging, discusses technique selection (primary vs. secondary repair, sphincteroplasty vs. SNM), and confirms candidacy. Step 3: GAF Healthcare initiates e-Medical Visa application for India (Indian e-Medical Visa allows up to 60-day stay, extendable) or UAE visa-on-arrival/entry visa coordination. Pre-operative dietary advice and bowel preparation instructions are issued. Cessation of anticoagulants (warfarin stopped 5 days pre-op; DOACs stopped 24–48 hours pre-op as per anaesthesia guidance) and NSAIDs is confirmed.

PHASE 2 — ARRIVAL AND PRE-OPERATIVE WORKUP (DAY 1–2 IN COUNTRY) Step 4: GAF airport transfer to hospital or partner accommodation. Pre-operative admission bloods (FBC, coagulation, metabolic panel, HbA1c, serology), ECG, and anaesthetic review. Bowel preparation (oral polyethylene glycol solution) initiated the evening before surgery for secondary/complex repairs. Prophylactic antibiotic protocol confirmed by the anaesthetic team.

PHASE 3 — SURGICAL PROCEDURE (DAY 2–3) Step 5 (Primary Repair): Performed under spinal or general anaesthesia. Operative time: 30–90 minutes depending on tear degree. Patient positioned in lithotomy. Systematic identification of all torn anatomical layers. Layered closure as per technique described. Intraoperative proctoscopy performed to confirm no inadvertent rectal suture placement. Urinary catheter inserted (Foley 12–14Fr) for 12–24 hours. Step 5 (Secondary/Complex Repair): Operative time: 1.5–3 hours. Includes rectal examination under anaesthesia, EAUS confirmation of defect intraoperatively if available, sphincteroplasty, perineorrhaphy, and/or fistula repair as planned. Suprapubic or urethral catheterisation for 24–48 hours. Intraoperative blood loss typically minimal (<200 mL); transfusion rare.