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Surgical Approaches to Postobstetrical Perineal Body Defects (Rectovaginal Fistula and Chronic Third and Fourth-degree Lacerations)

DELANCEY, JOHN O. L. MD*; MILLER, NORMAN F.; BERGER, MITCHELL B. MD, PHD

Clinical Obstetrics and Gynecology: March 2010 - Volume 53 - Issue 1 - p 134-144
doi: 10.1097/GRF.0b013e3181cf7488
Vaginal Surgery

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

Fellow in Female Pelvic Medicine and Reconstructive Surgery, University of Michigan, Women's Hospital, Ann Arbor, Michigan

Correspondence: John O. L. DeLancey, MD, Department of Obstetrics and Gynecology, University of Michigan, L4000 Women's Hospital, SPC 5275, Ann Arbor, MI. E-mail: delancey@med.umich.edu

© 2010 Lippincott Williams & Wilkins, Inc.