Traumatic deficient perineum: surgical management and outcome from a single center
Carlos Cerdán-Santacruz1,2, Óscar Cano-Valderrama3, Javier Cerdán-Miguel4
1Colorectal Surgery Department at Clínica Santa Elena, Madrid, Spain. carloscerdansantacruz@hotmail.com.
Insights
Surgical repair of deficient perineum, a condition causing anal incontinence, significantly improves fecal continence. Most patients reported satisfaction with functional outcomes after long-term follow-up.
Area of Science:
- Colorectal surgery
- Pelvic floor reconstruction
- Fecal incontinence management
Background:
- Deficient perineum involves disruption of the perineal body and rectovaginal septum, leading to anal incontinence and urogenital issues.
- Management is often delayed, with limited data on long-term outcomes of surgical repair.
- Surgical repair aims to restore structural integrity and improve functional continence.
Purpose of the Study:
- To evaluate long-term fecal continence outcomes following surgical repair of deficient perineum.
- To assess patient satisfaction with functional results after surgical intervention.
- To analyze the impact of surgical techniques on continence scores.
Main Methods:
- Retrospective analysis of 20 patients undergoing surgical repair between 1989 and 2012.
- Preoperative assessment included endosonography, anorectal manometry, and Cleveland Clinic Incontinence Score (CCIS).
- Surgical repair involved overlapping external anal sphincter (EAS) repair with levatorplasty, and selective internal anal sphincter (IAS) suture and/or perineoplasty.
Main Results:
- A significant decrease in median CCIS from 18 to 2 (p < 0.001) was observed postoperatively.
- 90% of patients reported satisfaction with functional outcomes after a median follow-up of 137.2 months.
- All patients had EAS and IAS defects; 70% received IAS suture and 50% underwent anoplasty.
Conclusions:
- Delayed surgical repair of deficient perineum yields acceptable medium- to long-term functional outcomes.
- Surgical intervention effectively improves fecal continence and patient satisfaction.
- This approach offers a viable solution without the need for fecal diversion.
Introduction And Hypothesis:
Deficient perineum is a disruption of the perineal body and distal rectovaginal septum presenting with anal incontinence and a range of urogenital symptoms. There is scarce reported outcome of this condition with management often delayed and with a variety of surgical alternatives. This study aims to determine faecal continence outcomes after long-term surgical repair.
Methods:
Patients were included for analysis after surgical repair between 1989 and 2012. Cases were preoperatively assessed by endosonography and anorectal manometry with a record of their continence with the Cleveland Clinic Incontinence Score (CCIS). Surgical repair comprised an overlapping repair of the external anal sphincter (EAS) with levatorplasty. There was selective use of internal anal sphincter (IAS) suture and/or advancement perineoplasty for soft tissue reconstruction. Patients were clinically evaluated for functional outcomes with comparison of their postoperative CCIS.
Results:
There were 20 patients (median age 55.5 years; range 29-81 years) with a median duration of incontinence symptoms of 174 (range 1-540) months. All patients had an EAS and IAS defect with 14 (70%) undergoing an IAS suture and 10 (50%) a Corman-style anoplasty. Over a median follow-up of 137.2 (range 13-322) months, there was a significant decrease in the recorded median preoperative vs. postoperative CCIS 18, range 13-20 vs. 2, range 0-10, respectively; p < 0.001) with 18 (90%) satisfied with the functional outcome. Faecal diversion was not used in any of the patients.
Conclusions:
Experienced delayed repair of a traumatic cloaca is associated with an acceptable functional outcome at medium- to long-term follow-up.
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