Bridging Gaps: Insights from a Rectal Buttonhole Tear Case Series

Area of Science:

• Obstetrics and Gynecology
• Colorectal Surgery

Background:

• Obstetric rectal buttonhole tears (ORBT) are overlooked rectal mucosal injuries.
• Delayed diagnosis can lead to rectovaginal fistulas and surgical referral.

Purpose of the Study:

• To describe the incidence and outcomes of ORBT.
• To evaluate a standardized repair technique for ORBT.

Main Methods:

• A case series of seven women with ORBT was conducted.
• Repairs were performed using a three-layer closure technique within 7 hours of injury.
• Outcomes were assessed at 3 months using physical examination and the St. Mark's incontinence score.

Main Results:

• The incidence of ORBT was 1 in 8571 deliveries.
• All seven repairs were successful, with no rectovaginal fistulas or complications.
• All patients achieved complete continence at 3 months (St. Mark's score 0/24).

Conclusions:

• Early recognition and structured management of ORBT are crucial.
• A standardized repair technique ensures excellent outcomes.
• Video-based training can improve obstetric practitioner management of ORBT.