Cloaca-like deformity with faecal incontinence after severe obstetric injury--technique and functional outcome of ano-vaginal and perineal reconstruction with X-flaps and sphincteroplasty.
Colorectal Dis
; 10(8): 827-32, 2008 Oct.
Article
in En
| MEDLINE
| ID: mdl-18205849
ABSTRACT
OBJECTIVE:
Surgical technique and outcomes report. SUMMARY BACKGROUND DATA Three to eight per cent of vaginal deliveries are complicated by third- or fourth- degree perineal lacerations, resulting in a cloaca-like deformity in up to 0.3%. These three-dimensional defects result in often debilitating incontinence and symptoms similar to a rectovaginal fistula because of the lack of the distal rectovaginal septum.METHOD:
Between 2001 and 2006, 12 women (median age 37, range 20-57) with faecal incontinence and a postobstetric-injury-associated cloaca-like deformity underwent an ano-vaginal and perineal reconstruction with X-flaps and sphincteroplasty without primary faecal diversion.RESULTS:
The patients presented 13.0 +/- 2.9 years (range 0.5-29 years) after the obstetric injury. The median Cleveland Clinic Florida faecal incontinence score was 16 (range 12-19). In addition, one patient complained of vaginal discharge, another of dyspareunia. All patients had an open rectovaginal communication with a large anterior sphincter defects (mean 160.2 +/- 22.8 degrees, range 113-180). Resting/squeeze pressures were 28.0 +/- 4.4/63.2 +/- 8.1 mmHg, respectively. Pudendal neuropathy was present in five patients. The median length of hospital stay after surgery was 5.3 +/- 0.7 days. Three patients experienced a postoperative rectovaginal fistula, two of which closed spontaneously, whereas the third required faecal diversion and a bulbocavernosus flap. After surgical follow-up of 9.8.3 +/- 2.8 months and long-term follow-up of 38.9.0 +/- 6.9 months, all the patients were satisfied with regards to overall function, continence and cosmetic result.CONCLUSION:
Cloaca-like deformity resulting from severe obstetric injury is often not given appropriate attention. Reconstruction of the original anatomy is complex but achieves good results and does not require a prophylactic faecal diversion.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Anal Canal
/
Surgical Flaps
/
Rectovaginal Fistula
/
Plastic Surgery Procedures
/
Fecal Incontinence
/
Obstetric Labor Complications
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Middle aged
/
Pregnancy
Language:
En
Journal:
Colorectal Dis
Journal subject:
GASTROENTEROLOGIA
Year:
2008
Document type:
Article
Affiliation country:
Estados Unidos