Complete laceration of the perineum and rectovaginal fistula: Management and end results

Abstract

1.1. A complete laceration of the perineum may be prevented by employing one of three methods when the indication arises: (1) perineotomy, (2) episiotomy, (3) manual dilatation of the perineum and vagina.2.2. Perineotomy, or median perineal incision, is of value when the disproportion between the presenting part and the vaginal outlet is moderate.3.3. Episiotomy or lateral perineal incision should be resorted to when a great deal of room is required, as in difficult forceps operations, and when the presenting part is overlarge.4.4. Manual dilatation of the perineum and vagina is a satisfactory method of preparing the birth canal before version and extraction operations.5.5. The technic of operation for repair of complete laceration of the perineum and rectovaginal fistula is discussed.6.6. The preoperative and postoperative care are described.7.7. Emphasis is placed on careful approximation of the tissues with fine suture material applied without tension.8.8. Ninety-two personal cases are reported.9.9. The end result was satisfactory in 90 patients, 98 per cent, 12 of whom, 13 per cent, developed postoperative complications. In two patients, approximately 2 per cent, discharged from the hospital with small rectovaginal fistulas, the final result was not ascertained.10.10. A careful preoperative preparation, meticulous technic, and postoperative care, preferably under the immediate supervision of the operator, play an important role in securing satisfactory healing.