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Sphincteroplasty and perineoplasty with skin advancement flap in management of traumatic cloacal defect / Esfincteroplastia e perineoplastia com retalho cutâneo de avanço no tratamento de defeito cloacal traumático
Anaraki, Fakhrolsadat; Etemad, Omid.
  • Anaraki, Fakhrolsadat; Shahid Beheshti University of Medical Sciences. Colorectal Division of Surgery Ward. Taleghani Hospital. Tehran. IR
  • Etemad, Omid; Shahid Beheshti University of Medical Sciences. Surgery Ward. Taleghani Hospital. Tehran. IR
J. coloproctol. (Rio J., Impr.) ; 37(1): 18-24, Jan.-Mar. 2017. tab, graf, ilus
Article in English | LILACS | ID: biblio-841304
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.
RESUMO
RESUMO Experiência Defeito cloacal traumático (RCT) é a condição que ocorre em 0,3% das mulheres que sofreram laceração perineal de terceiro/quarto grau durante um parto vaginal natural (PNV) traumático. Essa condição causa muitos efeitos indesejáveis em suas vidas. A cirurgia é a melhor forma de reparar essa deformidade, e melhorará a qualidade de vida nessas pacientes. Modelo Nesse estudo, estudamos prospectivamente 19 pacientes que foram encaminhadas ao hospital com sintomas de RCT entre 2011 e 2015, com uma media de 2,6 anos de seguimento. Todas foram submetidas a uma esfincteroplastia e perineoplastia, com retalho cutâneo de avanço.

Resultados:

Da totalidade de 19 pacientes, a incontinência para fezes sólidas em 16 pacientes (84%), a incontinência para fezes líquidas em 15 pacientes (78%) e a incontinência para flatos em quatro pacientes (21%) foram completamente resolvidas. Ocorreu redução no escore FI, de uma media de 12,7 para 2,6. A função sexual melhorou significativamente em todas as pacientes, e a dispareunia desapareceu completamente em nove pacientes (50%). O escore para qualidade de vida melhorou, da media de 45 para 95. Ocorreram complicações pós-operatórias em três pacientes (infecção da ferida em dois casos e fistula retovaginal no caso restante).

Conclusão:

Nossos achados demonstram que a esfincteroplastia e a perineoplastia com retalho cutâneo de avanço é técnica cirúrgica efetiva para o reparo do corpo perineal, graças a seus benefícios e às poucas complicações. Nesse estudo, foi observada melhora siga na qualidade de vida de praticamente todas as pacientes em seguida a essa cirurgia reconstrutiva. Para tais casos, é recomendável uma consulta com um cirurgião colorretal.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Perineum / Quality of Life / Surgical Flaps / Plastic Surgery Procedures / Sphincterotomy Type of study: Prognostic study Limits: Adult / Aged / Female / Humans / Pregnancy Language: English Journal: J. coloproctol. (Rio J., Impr.) Journal subject: Cirurgia / Doen‡as Retais / Doen‡as do Colo / Gastroenterology / Cirurgia Year: 2017 Type: Article Affiliation country: Iran Institution/Affiliation country: Shahid Beheshti University of Medical Sciences/IR

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Full text: Available Index: LILACS (Americas) Main subject: Perineum / Quality of Life / Surgical Flaps / Plastic Surgery Procedures / Sphincterotomy Type of study: Prognostic study Limits: Adult / Aged / Female / Humans / Pregnancy Language: English Journal: J. coloproctol. (Rio J., Impr.) Journal subject: Cirurgia / Doen‡as Retais / Doen‡as do Colo / Gastroenterology / Cirurgia Year: 2017 Type: Article Affiliation country: Iran Institution/Affiliation country: Shahid Beheshti University of Medical Sciences/IR