Deoti surgical flap and sphincteroplasty for treatment of severe perineal deformity

Abstract

Purpose Anal incontinence is a very stigmatizing condition, which affects biopsychosocially the patient. It is a neglected, but quite common complication of obstetric and anorectal surgery, however it has treatment options. None of the treatment options have exceptional efficacy rates and still associated with risk of recurrence. The surgery techniques known are: anterior and posterior shortening procedure; post-anal repair; anterior elevator plasty and external sphincter plication; total pelvic floor repair and sphincter repair. None of them use a flap rotation of adipose tissue. The purpose is to propose a new surgery technique of anal sphincteroplasty, which uses flap rotation, for severe perineal deformity associated with anal incontinence. Methods Patient with severe perineal deformity and anal incontinence treated with a new surgery technique of sphincteroplasty with flap rotation. Results The severe perineal deformity was corrected with both esthetic and functional results. Anal continence measured by Wexner and Jorge assessment in a follow-up period of 2 years after the intervention. Pictures and video show esthetic and functional aspects. Conclusion This is the first time that a flap rotation is used to treat a severe perineal deformity. And the technique presented promising outcomes, which allows perineum reconstruction that is similar to the original anatomy. Therefore, this technique is justified to better evaluate its efficiency and the impact on patients’ prognosis.

Technique and results of the first six cases of anal sphincteroplasty with Deoti's flap for complex anatomical deformity of the perineum

“…This contact prevents extensive fibrosis and adhesion of the skin fibrosis to the muscle tissue, due to many stem and progenitor cells present in subcutaneous fat. 5 Our study aims to provide a useful report for the future treatment of severe perineal deformity, which is fortunately rare, giving us a small number of cases. These cases showed that the Deoti's flap had important and positive impacts on the patient's scores.…”

“…The surgical technique used, described in details at Rodrigues, Buzatti et al, 5 is based on the principle for an optimal suture ( Fig. 1) and the benefits of fat grafting.…”

“…2 In less advanced FI, clinical treatment has shown excellent results and it is based on high fiber diet and bulking agents, aiming a more consistent stool and, depending on the patient, antidiarrheal medication can be used. 2,5 The classic surgery indication is for complete sphincter disruption, successfully treated with sphincteroplasty. 2 The most used surgical technique available is the anterior overlapping sphincteroplasty, that shows good short-term functional results, but, over time, declines, starting specially after two years, which can be objectively assessed by FI questionnaires.…”