Little information is available to assist in the management of a dehiscence subsequent to a fourth degree episiotomy repair. Delayed repair of the external sphincter ani muscle and rectal mucosa may result in weeks or months of disability and inconvenience for these women. A series of eight women is presented whose fourth degree episiotomy repair dehiscence was managed by early puerperal repair. The details of wound and bowel preparation, the operative technique, and postoperative care are described. Because all eight women had a successful repair, the authors believe that early surgical correction is an acceptable treatment for this puerperal complication. (C) 1986 The American College of Obstetricians and Gynecologists. © 1986 The American College of Obstetricians and Gynecologists.