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Traumatic deficient perineum: surgical management and outcome from a single center

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Abstract

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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Acknowledgements

We thank Prof. A.P. Zbar for his critical review of the manuscript.

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Authors and Affiliations

  1. Colorectal Surgery Department at Clínica Santa Elena, Madrid, Spain

    Carlos Cerdán-Santacruz & Javier Cerdán-Miguel

  2. Colorectal Surgery Department at Hospital Universitario de la Princesa, Madrid, Spain

    Carlos Cerdán-Santacruz

  3. General Surgery Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain

    Óscar Cano-Valderrama

Authors
  1. Carlos Cerdán-Santacruz
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  2. Óscar Cano-Valderrama
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  3. Javier Cerdán-Miguel
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Correspondence to Carlos Cerdán-Santacruz.

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The authors of the article do not have any commercial association that might pose a conflict of interest in relation to this article.

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The study protocol was approved by the Local Ethics Committee.

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Cerdán-Santacruz, C., Cano-Valderrama, Ó. & Cerdán-Miguel, J. Traumatic deficient perineum: surgical management and outcome from a single center. Int Urogynecol J 33, 651–658 (2022). https://doi.org/10.1007/s00192-021-04803-0

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