Sphincteroplasty and perineoplasty with skin advancement flap in management of traumatic cloacal defect

Abstract

Abstract Background Traumatic cloacal defect (TCD) is the condition that occurs in 0.3% of women who have experienced the third/fourth-degree perineal laceration during traumatic Natural Vaginal Delivery (NVD). This condition has many undesirable effects in their lives. Surgery is the best way to repair this deformity and will improve the quality of life in these patients. Design In this study, we prospectively studied 19 patients who were referred to the hospital with symptoms of TCD within years 2011 and 2015 with the mean of 2.6-yrs follow-up. They all underwent sphincteroplasty and perineoplasty with skin advancement flap. Results Of all 19 patients, incontinence to solid faeces in 16 patients (84%), incontinence to liquid stool in 15 patients (78%) and incontinence to flatus in 4 patients (21%) were completely resolved. The FI score was decreased from the mean of 12.7 to 2.6. Sexual function was significantly improved in all of them and dyspareunia was completely disappeared in 9 patients (50%). The quality of life score was increased from the mean of 45 to 95. Post-operation complications were occurred in 3 of patients (wound infection in 2-cases and recto-vaginal fistula in another). Conclusion Our findings show that sphincteroplasty and perineoplasty with skin advancement flap is an effective surgical technique to repair the perineal body due to its benefits and few complications. In this study, there was significant improvement in quality of life of almost all patients after this reconstructive surgery. Consulting with a colorectal surgeon is recommended for these cases.