Title: clinical and functional outcome of surgery for posttraumatic cloacal deformity authors: arcangelo picciariello1 | gaetano gallo2 | alessandro sturiale3 | francesco litta4 | veronica de simone4 | gennaro martines1 | gabriele naldini3 | carlo ratto4 | mario trompetto5 | marcella rinaldi1 citation: colorectal disease.2021;00:1¿7.Doi: 10.1111/codi.16008.The aim of this multicentre retrospective study is to assess the clinical and functional outcome of patients treated for traumatic cloacal deformity using three different surgical techniques.A total of 38 women (with a median age of 34 years [interquartile range (iqr) 31¿39 years]) operated on for fourth-degree cloacal deformity between january 2015 and january 2019 were included in the study.After the anoplasty, perineoplasty was performed in 3 different techniques.In 23 patients, direct suture of the rectovaginal septum was performed by: an end-to-end or overlapping sphincteroplasty is carried out using separate nonabsorbable (pds 3/0) stitches and the reconstruction is completed with longitudinal midline closure of the perineal skin by interrupted sutures (unknown) (figure 1a).In 10 patients, singapore flap technique was performed by: the flap is lifted up by the upper part, left-rotated by 90° and fixed (interrupted vicryl® 3/0) in order to cover the repaired external sphincter (figure 1b).In 5 patients, the x-flap technique was performed by: the posterior wall of the vagina and the anterior wall of the anal canal are then reconstructed by two 2/0 polyglactin sutures each (vicryl®, ethicon inc.); subsequently, an overlapping or end-to-end sphincteroplasty is performed; the anterior perineal plane is then reconstructed from transverse muscles of the perineum; the flaps are then transposed beyond the midline and sutured by poliglecaprone sutures (monocryl®, ethicon inc.; figure 1c).A diverting stoma was performed in 3 patients after x-flap perineoplasty and in 14 treated by direct closure.Reported complications include surgical wound infection classified as clavien-dindo ii (n=2) in the singapore flap group and clavien-dindo iii (n=1) in the direct closure group which require a second-look surgery in the patients in the direct closure group; and wound problems with no infection (n=14) nine patients with the direct closure, two patients with the x-flap and three patients in the singapore flap group.In conclusion, regardless of the technique used, surgical repair significantly improves both clinical and functional outcomes irrespective of the presence of a covering stoma.Nevertheless, even if in this relatively large series there was no difference in term of complication rate, the need to perform a protective diverting stoma should be better addressed by a randomized clinical trial.
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Product complaint # (b)(4).Attempts are being made to obtain the following information.To date no response has been provided.If further details are received at a later date a supplemental medwatch will be sent.Does the surgeon believe that any of the ethicon products involved caused and/or contributed to the post-operative complications described in the article? does the surgeon believe there was any deficiency with any of the ethicon products used in this procedure? if so, please provide details.Were the cases discussed in this article previously reported to ethicon? if yes, please provide a complaint reference number.Patient demographics? this report is related to a journal article; therefore, no product will be returned for analysis and the batch history records cannot be reviewed as the lot number has not been provided.(b)(4).The single complaint was reported with multiple events.There are no additional details regarding the additional events.Related events captured via 2210968-2022-03863.Citation: colorectal disease.2021;00:1¿7.Https://doi.Org/10.1111/codi.16008.
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