Management of fourth degree obstetric perineal tear without colostomy using non - stimulated gracilis - our experience over eleven years

Abstract

Background:Although gracilis muscle transposition for faecal incontinence has been well-described method, its literature for use in obstetric perineal tear without colostomy is sparse. In this study, we have tried to analyse its use in fourth-degree obstetric perineal tears.Patients and Methods:A total of 30 patients with recto-vaginal fistula with faecal incontinence secondary to obstetric perineal tear were retrospectively studied between February 2003 and May 2014. The recto-vaginal fistula was explored, dissected and identification of sphincters was done using muscle stimulator. Fistula closure was done followed by sphincter repair, vaginal tightening procedure and single gracilis transposition. None of the patients had covering colostomy. Faecal incontinence was assessed pre- and post-operatively by digital rectal examination (single examiner), Park's score and Corman's score in all cases and using barium hold and transperineal ultrasonography, manometric studies in a few cases. The outcome was measured at an average follow-up of 8.8 months (7–24 months).Results:As per Park's score 26 patients had Grade I continence, two had Grade II and two patients had Grade III continence. Corman's score improved from fair to excellent in 26 patients. The patients in whom manometry was performed showed a remarkable rise in both resting and squeeze pressures. Two patients developed post-operative infections in upper 1/3 thigh incision site and three patients at gluteal region scar site.Conclusion:Satisfactory continence following gracilis muscle could be achieved.

Gracilis Muscle Interposition for the Treatment of Rectovaginal Fistula: A Systematic Review and Pooled Analysis

“…[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] The characteristics of the included studies are reported in Table 1. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Of the 20 included studies, 19 were case series (18 retrospective, 1 prospective), whereas 1 was a prospective cohort study. Six studies (30%) included only our population of interest [21][22][23][24][25][26] ; 11 studies (55%) also included other types of fistulas [27][28]…”

“…[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Of the 20 included studies, 19 were case series (18 retrospective, 1 prospective), whereas 1 was a prospective cohort study. Six studies (30%) included only our population of interest [21][22][23][24][25][26] ; 11 studies (55%) also included other types of fistulas [27][28][29][30][31][32][33][34][35][36][37] and 3 studies (15%) also included other interventions. [38][39][40] The risk of bias evaluation is reported in Table 2 and Supplemental Figure 1 patients; 26%), complications from previous pelvic surgery (78 patients; 20%), and obstetric injury (73 patients; 19%).…”

“…The characteristics of the included studies are reported in Table 1. 21-40 Of the 20 included studies, 19 were case series (18 retrospective, 1 prospective), whereas 1 was a prospective cohort study. Six studies (30%) included only our population of interest 21–26 ; 11 studies (55%) also included other types of fistulas 27–37 and 3 studies (15%) also included other interventions.…”

“…21-40 Of the 20 included studies, 19 were case series (18 retrospective, 1 prospective), whereas 1 was a prospective cohort study. Six studies (30%) included only our population of interest 21–26 ; 11 studies (55%) also included other types of fistulas 27–37 and 3 studies (15%) also included other interventions. 38–40 The risk of bias evaluation is reported in Table 2 and Supplemental Figure 1 at https://links.lww.com/DCR/C146.…”

“…Data regarding symptoms at the donor site were reported by 6 studies [21][22][23]25,26,32 ; symptoms included pain, functional issues, sensory disturbances, deep vein thrombosis, and scar hypertrophy. Park et al reported no donor site discomfort.…”