Surgical approaches to postobstetrical perineal body defects (rectovaginal fistula and chronic third and fourth-degree lacerations).
Rectovaginal fistulas and chronic anal sphincter lacerations are uncommon complications that are most often secondary to vaginal delivery, gynecologic surgery, and inflammatory bowel disease. In this chapter, we will review the pertinent anatomy, focusing on the 6 structures that should be considered during the repair and surgical techniques to promote restoration on normal anatomy and function. Key concepts include a tension-free repair, meticulous hemostasis, and postoperative bowel management.
Department Obstetrics and Gynecology, University of Michigan, Women's Hospital, Ann Arbor, Michigan, USA. delancey@med.umich.edu
John O L
JO
Delancey
Norman F
NF
Miller
Mitchell B
MB
Berger
D001003:Anal Canal / Q000293:injuries* / Q000601:surgery; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications; D022125:Lacerations / Q000209:etiology / Q000601:surgery*; D056888:Patient Positioning; D011300:Preoperative Care; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome