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Introduction: Obstetric anal sphincter injuries (OASIS) are defined as a disruption of the anal sphincter during vaginal delivery. Third-degree tears involve injury to the external anal sphincter and/or internal anal sphincter. Fourth-degree tears extend through the rectal mucosa. In Switzerland, the incidence of OASIS ranges from 2.0% in spontaneous vaginal births to 7.4% in instrumental vaginal deliveries [1]. OASIS causes significant morbidity, including anal incontinence, rectovaginal fistula and pain, thereby negatively affecting women’s quality of life in the short and long term [2].

In Uganda, a low-income country, access to obstetric and medical care is limited, and treatment is therefore often delayed. Many women with OASIS live with permanent incontinence, leading to social and economic stigma.

For over a decade, annual one-week surgical camps have been organized at Bwindi Community Hospital and Mbarara University of Science and Technology (MUST). These camps provide surgical treatment for women with OASIS and train young local physicians within an accredited urogynaecology fellowship program.

Methods: During the 2025 surgical camp at MUST, the repair of a fourth-degree perineal tear was recorded. In addition, a simple simulation model was developed to demonstrate the stepwise management of a fourth-degree perineal tear.

Results: The video demonstrates the stepwise management of a fourth-degree perineal tear. It first presents the repair technique on a simulation model, focusing on anatomical orientation and surgical principles, followed by its application in the operating room.

Conclusion: This film serves as a training video for physicians involved in the management of OASIS. It highlights standardized steps for repairing OASIS and emphasizes the importance of teaching. In addition, the film demonstrates how simple simulation models can be used to practice and teach OASIS repair skills.

Literatur

[1] Bundesamt für Statistik (BFS). Medizinische Statistik der Krankenhäuser. Entbindung und Gesundheit der Mütter im Jahr 2017. Neuchâtel, Schweiz: BFS; 2019. Verfügbar unter: https://www.bfs.admin.ch/asset/en/8369420
[2] Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), et al. S2k-Leitlinie Management von Dammrissen III. und IV. Grades nach vaginaler Geburt. AWMF-Registernummer 015-079. AWMF; 2020. Verfügbar unter: https://register.awmf.org/de/leitlinien/detail/015-079