Sunday, February 24, 2013

Bilateral X Flap repair for Faecal incontinence

Recently came across a lady in her mid 50s who have four normal deliveries.After her last delivery she realized that she has lost control over her stool particularly when it was little loose.It was commendable on part of this female that at least she had taken the bold step to ask for help.Before visiting us she had visited few other quite big hospital,big names,famous surgeons,famous gynaecologists........a diagnosis of recto vaginal fistula was established.When we examined her it was found that due to traumatic child birth the recto vaginal septum has thinned out,anal sphincter fibers were missing in front and there was no perineal body.She didn't have a Recto vaginal Fistula.

A plan was made to correct her problem.It meant dissecting the vaginal septum from the rectum,identify the two ends of anal sphincter,repairing the old torn anal sphincter,strengthening the rectal mucosa as well as vaginal wall and finally to make skin flap to act as her perineal body.
The surgery involved myself and colorectal surgeon Dr Shalabh Mohan.Either of us could have done it individually but a team effort always gives a better result as you can see from the pictures which follow.Can't finish the post without saying thanks to Dr Deepa Maheshwari for a nice assistance.


It is also important that the Obstetricians are well trained in repairing 3rd and 4th degree perineal tear.If not confident oneself ,one should never shy away in asking any help from some one better trained as it can compromise very badly the quality of life of the lady concerned.

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