Layered surgical repair of traumatic cloacal deformities: technical details and functional outcomes

Abstract

Traumatic cloaca due to severe obstetric injury is a disabling condition that results in debilitating fecal incontinence, sexual dysfunction, and psychosocial distress for the patients, and poses a complex and challenging clinical situation for the surgeon. The aim of this study is to describe our technique and functional outcomes for the surgical repair of traumatic cloacal deformities. Between 2000 and 2010, four women with traumatic cloacal deformities related to obstetric injury underwent repair by a single surgeon. In all patients, a systematic layered repair of the anovaginal structures was performed, including internal and external sphincteroplasties, without the implementation of tissue flaps or fecal diversion. Anorectal function before and after surgery as well as wound healing was evaluated. The patients presented 4.8 years after the obstetric injury. Mean preoperative Fecal Incontinence Severity Index was 34. All patients had complete disruption of the perineum, anal canal, distal vagina, and rectum, with a mean external sphincter defect of 151 degrees. Postoperatively, there were no wound-related complications and complete healing occurred by the fourth week. Median long-term follow-up was 4.5 years. At long-term follow-up, mean postoperative Fecal Incontinence Severity Index score was zero and all patients reported complete absence of dyspareunia. A layered surgical repair of cloacal deformities after severe obstetrical injury is associated with excellent functional outcomes and cosmetic results. The need for fecal diversion or complex surgical flaps for wound closure is obviated in this small series.