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Войти в исследования Surgery today · 2025
Perineal body reconstruction surgery for a cloaca-like deformity following vaginal delivery: a case series of seven patients.
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Murakami Koichiro, Nishimura Yumi, Mizukuro Tomoyuki
Аннотация
PURPOSE: A cloaca-like deformity following vaginal delivery is a rare obstetric complication that significantly impacts the patient's quality of life. No standard treatment protocols have yet been established, with some centers advocating diverting colostomy. This study aimed to evaluate the efficacy and safety of primary perineal body reconstruction without colostomy.
METHODS: We retrospectively analyzed seven consecutive cases of post-delivery cloaca-like deformities treated with primary perineal body reconstruction between June 2022 and September 2024. The outcome measures included operative time, blood loss, complications, functional outcomes using the Wexner incontinence scores, and the recurrence rate.
RESULTS: All patients underwent a successful one-stage repair. The median operative time was 110 min (range: 85-168), and the median blood loss was 131 ml (range: 60-610). One patient (14.3%) experienced minor wound dehiscence that was conservatively managed. The postoperative hospital stay was 8 days in all cases. The Wexner incontinence scores improved significantly from a preoperative median of 12 (range: 5-17) to postoperative 4 (range: 0-14) (p < 0.0223). The sexual function improved in all cases, with two patients achieving subsequent pregnancy and delivery. No recurrence was observed during a mean follow-up of 9.7 ± 2.9 months.
CONCLUSION: Primary perineal body reconstruction is a safe and effective treatment option for post-delivery cloaca-like deformities, thereby avoiding the need for diverting colostomy in appropriately selected patients. However, given the small sample size and retrospective nature of this study, our conclusions remain tentative.
METHODS: We retrospectively analyzed seven consecutive cases of post-delivery cloaca-like deformities treated with primary perineal body reconstruction between June 2022 and September 2024. The outcome measures included operative time, blood loss, complications, functional outcomes using the Wexner incontinence scores, and the recurrence rate.
RESULTS: All patients underwent a successful one-stage repair. The median operative time was 110 min (range: 85-168), and the median blood loss was 131 ml (range: 60-610). One patient (14.3%) experienced minor wound dehiscence that was conservatively managed. The postoperative hospital stay was 8 days in all cases. The Wexner incontinence scores improved significantly from a preoperative median of 12 (range: 5-17) to postoperative 4 (range: 0-14) (p < 0.0223). The sexual function improved in all cases, with two patients achieving subsequent pregnancy and delivery. No recurrence was observed during a mean follow-up of 9.7 ± 2.9 months.
CONCLUSION: Primary perineal body reconstruction is a safe and effective treatment option for post-delivery cloaca-like deformities, thereby avoiding the need for diverting colostomy in appropriately selected patients. However, given the small sample size and retrospective nature of this study, our conclusions remain tentative.