The posterior sagittal approach for reconstruction of severe rectovaginal injuries

Abstract

Reconstruction of major perineal lacerations in the small child is difficult and frequently results in less-than-satisfactory continence. A 2 1 2 - year-old girl who had sustained a fourth-degree perineal laceration at 9 months of age presented with a common rectovaginal orifice and complete fecal incontinence. Repair was carried out via a posterior sagittal approach, resulting in a normal-appearing perineum with complete continence. The techniques used in the posterior sagittal approach allow precise identification of the striated muscle complex and, therefore, offer a valuable means of achieving complete continence. Although the technique was originally described for reconstruction of congenital anomalies, this report demonstrates it to also be useful for reconstruction of severe perineal trauma.