Porcine Anal Sphincter Model for Fourth-Degree Laceration Repair Simulation: Overlapping Technique

INTRODUCTION: Up to 11% of women will sustain an obstetric anal sphincter injury at the time of childbirth, increasing the risk for fecal and flatal incontinence. Trainees do not have ample experience with complex laceration repair, specifically with the overlapping technique for external anal sphincter repair. OBJECTIVE: The objective of this video is to demonstrate the repair of a fourth-degree perineal laceration using a high-fidelity porcine anal sphincter model, focusing on the overlapping technique for external anal sphincter repair. METHODS: The required materials for this simulation include a protected work surface, gloves, porcine anal sphincter, scissors, needle driver, tissue forceps, and 2-0 and 3-0 delayed absorbable suture. The porcine anal sphincter is transected at the 12-o’clock position to simulate a fourth-degree laceration. The sphincter is affixed to a work surface with suture. The anorectal mucosa is first repaired in a running fashion using 3-0 delayed absorbable suture. The internal anal sphincter is then repaired end-to-end with horizontal mattress sutures using 3-0 delayed absorbable suture. Lastly, the external anal sphincter is repaired using an overlapping technique with four full-thickness mattress sutures using 2-0 delayed absorbable suture. RESULTS: Residents responded positively to the model and stated that animal tissue provided realistic haptic simulation based on pre- and post-simulation questionnaires. All participating residents felt strongly about recommending this simulation to a colleague. CONCLUSIONS: This porcine anal sphincter model provided excellent perceived haptic fidelity. Moreover, it is a well-received teaching tool to augment faculty and resident education.