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Updated: Jun 21, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Outcomes following repair of traumatic cloacal deformities
J R F Hollingshead1, J Warusavitarne, C J Vaizey
1Department of Surgery, St Mark's Hospital, Watford Road, Harrow HA1 3UJ, UK.
Insights
Surgical repair significantly improves fecal incontinence and sexual function in patients with severe obstetric injuries resembling cloacal deformities. Long-term outcomes demonstrate sustained benefits, comparable to less severe injury repairs.
Area of Science:
- Obstetrics and Gynecology
- Colorectal Surgery
- Reconstructive Surgery
Background:
- Severe obstetric injuries can mimic congenital cloacal deformities.
- These injuries lead to debilitating fecal incontinence and sexual dysfunction.
- Surgical intervention is explored for functional restoration.
Purpose of the Study:
- To evaluate the efficacy of surgical repair for severe obstetric injuries.
- To assess improvements in fecal incontinence and sexual function post-surgery.
Main Methods:
- Retrospective review of 31 patients over 14 years.
- Surgical repair involved overlapping external sphincter, anorectum, and vagina reconstruction.
- Long-term follow-up via telephone interview for 20 patients (median 5 years post-surgery).
Main Results:
- Fecal incontinence to solid stool resolved in all 20 patients.
- Incontinence to liquid stool reduced from 14/17 to 10/20.
- Incontinence to flatus reduced from 17/17 to 12/20.
- Nine patients reported improved sexual function.
Conclusions:
- Surgical repair offers significant improvements in fecal incontinence and sexual function.
- Outcomes are comparable to repairs of less severe injuries.
- Benefits appear to be maintained long-term.
Background:
Severe obstetric injury can result in a defect similar to a congenital cloacal deformity, with associated faecal incontinence and sexual dysfunction. The aim of this study was to assess the efficacy of surgical repair of such injuries.
Methods:
Patients were identified retrospectively from hospital records. Long-term follow-up data were collected by telephone interview.
Results:
Outcomes in 31 consecutive patients seen over a 14-year period were reviewed. An overlapping external sphincter repair, with repair of the anorectum and vagina, was performed in 29 patients. Detailed long-term follow-up data were available for 20 patients at a median of 5 years after surgery. Three patients had a stoma at presentation. Surgical repair reduced incontinence to solid stool from seven of 17 to none of 20 patients, to liquid stool from 14 of 17 to ten of 20, and to flatus from 17 of 17 to 12 of 20. Nine patients reported improvement in sexual function.
Conclusion:
Surgical repair of a cloacal injury is associated with significant improvements in faecal incontinence and sexual function. Outcomes are similar to those seen with repair of less severe injuries, and may be maintained in the long term.
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