背景:后矢状肛门直肠成形术(PSARP)后,经皮吻合和/或会阴体重建的伤口裂开是一种令人恐惧的围手术期并发症。会阴体的开裂可能对大便失禁有长期的负面影响,性亲密,产科结果,以及再次手术的需要.我们描述了对传统PSARP的修改,用于修复直肠前庭的无孔肛门,会阴,或者通过保留会阴体而没有瘘管,消除术后会阴体裂,并可能改善长期功能结局。
方法:回顾性分析女性直肠前庭患者,会阴,或在保留会阴体的情况下接受PSARP的瘘管缺失。
结果:6例患者在2019年至2022年期间接受了PSARP,保留了会阴体。无围手术期并发症。在后续行动中,所有患者都有规律的肠道功能,没有困难,会阴体外观良好。
结论:直肠前庭的PSARP,会阴,或不存在瘘管可以用更有限的切口安全地进行,以避免会阴体的破坏。这消除了手术期间会阴体重建的需要,从而防止伤口开裂。鉴于伤口裂开的严重长期不良后遗症以及由此导致的会阴体不足,我们认为,对PSARP的这一修改值得强烈考虑。
BACKGROUND: Wound dehiscence of the anocutaneous anastomosis and/or reconstructed perineal body is a feared perioperative complication after posterior sagittal anorectoplasty (PSARP). Dehiscence of the perineal body can have long-term negative implications for fecal continence, sexual intimacy, obstetrical outcomes, and the need for reoperative surgery. We describe a modification to the traditional PSARP for repair of an imperforate anus with a rectovestibular, perineal, or absent fistula by sparing the perineal body, eliminating postoperative perineal body dehiscence and potentially improving long-term functional outcomes.
METHODS: A retrospective review of female patients with a rectovestibular, perineal, or absent fistula who underwent PSARP with sparing of the perineal body was performed.
RESULTS: Six patients underwent PSARP with sparing of the perineal body between 2019 and 2022. There were no perioperative complications. At follow-up, all patients are having regular bowel function without difficulty and have an excellent appearance of their perineal body.
CONCLUSIONS: PSARP for a rectovestibular, perineal, or absent fistula can be safely performed with a more limited incision to avoid disruption of the perineal body. This eliminates the need for perineal body reconstruction during the procedure, thereby preventing wound dehiscence. Given the significant long-term adverse sequelae of wound dehiscence and resultant inadequate perineal body, we believe this modification to the PSARP warrants strong consideration.