Modified Perineal Reconstruction Combined with Anal Sphincter Repair for Obstetric Anal Sphincter Injuries

Xu Wang,&ast; Yi-Nan Liu,&ast; Di Sun, Si Chen, Bao-Lei Huang, Jian-Dong Tai Department of Colorectal Surgery, The First Hospital of Jilin University, Changchun, 130000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jian-Dong Tai, Department of Colorectal Surgery, the First Hospital of Jilin University, No. 1 of Xinmin Street, Chaoyang District, Changchun, 130000, People’s Republic of China, Tel +86 431-88782291, Fax +86 431-85612352, Email taijdmed@163.comObjective: The aim of this study was to investigate the clinical effectiveness of modified perineal reconstruction combined with anal sphincter repair in the treatment of obstetric anal sphincter injuries (OASIS).Methods: Twenty consecutive patients with an OASI who underwent modified perineal reconstruction combined with anal sphincter repair in the Department of Colorectal and Anal Surgery of the First Hospital of Jilin University from October 2015 to September 2017 were retrospectively enrolled in this study. Anal function was evaluated using the Williams grade, the Wexner score, anorectal manometry, and transrectal ultrasound.Results: Differences in both the Williams grade and the Wexner score prior to operation and following surgery indicated that anal function had improved, and these differences were statistically significant (P < 0.05). These indices also showed further improvement six months after surgery as compared with values at one month, and again, these differences were statistically significant (P < 0.05). In addition, anorectal manometry at six months following surgery showed statistically significant differences in the maximum anal resting pressure, maximum anal systolic pressure, and anal defecation pressure as compared with values prior to operation (P < 0.05). Postoperative endorectal ultrasound revealed that the anal sphincter presented with close imbricated overlapping.Conclusion: Modified perineal reconstruction combined with anal sphincter repair in the treatment of female perineal defect is associated with a good clinical outcome, strengthening anal function, and reconstructing the perineum, and is a possible method for clinical treatment.Keywords: modified perineal reconstruction, bilateral V-Y island flap, perineal laceration, fecal incontinence, anal functio