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The posterior sagittal approach for reconstruction of severe rectovaginal injuries
1Department of Surgery, Kaiser-Permanente Medical Center, Los Angeles, CA 90027.
Insights
Reconstructing severe perineal lacerations in children using the posterior sagittal approach can restore fecal continence. This technique precisely identifies critical muscles, offering a valuable solution for trauma reconstruction.
Area of Science:
- Pediatric surgery
- Colorectal surgery
- Anorectal reconstructive surgery
Background:
- Major perineal lacerations in children are challenging to reconstruct.
- Existing methods often yield suboptimal fecal continence outcomes.
- Fourth-degree perineal lacerations pose significant reconstructive difficulties.
Observation:
- A 2.5-year-old girl with a fourth-degree perineal laceration presented with a rectovaginal fistula and fecal incontinence.
- The patient had sustained the injury at 9 months of age.
- A common rectovaginal orifice was noted.
Findings:
- Surgical repair was performed using the posterior sagittal approach.
- This technique allowed for precise identification of the striated muscle complex.
- The repair resulted in a normal-appearing perineum and complete fecal continence.
Implications:
- The posterior sagittal approach is effective for reconstructing severe perineal trauma in children.
- This method offers a valuable means to achieve complete fecal continence after trauma.
- The technique, adapted from congenital anomaly repair, shows promise for traumatic injuries.
Abstract:
Reconstruction of major perineal lacerations in the small child is difficult and frequently results in less-than-satisfactory continence. A 2 1/2-year-old girl who had sustained a fourth-degree perineal laceration at 9 months of age presented with a common rectovaginal orifice and complete fecal incontinence. Repair was carried out via a posterior sagittal approach, resulting in a normal-appearing perineum with complete continence. The techniques used in the posterior sagittal approach allow precise identification of the striated muscle complex and, therefore, offer a valuable means of achieving complete continence. Although the technique was originally described for reconstruction of congenital anomalies, this report demonstrates it to also be useful for reconstruction of severe perineal trauma.