ANTERIOR ANAL SPHINCTEROPLASTY SURGERY WITH PERINEAL RECONSTRUCTION VIA Z-PLASTY

Introduction Injury to the external anal sphincter can occur as a result of obstetric trauma, colorectal surgeries, or in the context of polytrauma, potentially leading to social impairment and loss of quality of life when associated with fecal incontinence.

Objective To demonstrate the technique of anterior anal sphincteroplasty with perineal reconstruction via Z-plasty.

Methods A 37-year-old female patient was referred to the Coloproctology outpatient clinic with complaints of fecal incontinence (Wexner score = 15) following a vaginal delivery with a Grade IV perineal tear two years prior. Upon examination, there was significant reduction in the perineal body due to scar tissue, with a slightly open anus and a hypotonic sphincter with low-amplitude voluntary contraction. Anorectal manometry showed the absence of a functional anal canal with a resting pressure of 20 mmHg, a contraction pressure of the EAS of 29 mmHg, and a total voluntary contraction pressure of 39 mmHg. Colonoscopy was normal. Pelvic MRI revealed partial fat substitution in the right levator ani muscles. Surgical technique: Dissection of the rectovaginal septum and separation of the vaginal wall from the anterior rectal wall, with identification of the remaining muscle fibers of the EAS, and suturing them together with Vicryl 2-0. Bilateral V-shaped incision in the perineal skin. Transverse incision in the perineal body. Release of flaps and creation of a Z-plasty flap (PDS 3-0) for reconstruction and elongation of the perineal body. A sigmoidostomy was performed for intestinal diversion.

Results The patient recovered well after the procedure and was discharged on the third postoperative day without wound dehiscence, local infection, or other clinical-surgical complications. Over 90 days postoperatively, the patient expressed high satisfaction with the surgical result, reporting significant aesthetic improvement and recovery of fecal continence, with plans for further anorectal manometry and surgery for reconstruction of intestinal transit.

Conclusion Anterior anal sphincteroplasty with perineal reconstruction via Z-plasty is a surgical technique with excellent aesthetic and functional results in the medium-to-long term in cases of EAS injury, especially in younger patients.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025