Modification of layered technique in traumatic cloaca
IUGA Academy. Thariani K. Jun 30, 2018; 213260
Topic: Anal Incont - Fecal Urgency
Dr. Karishma Thariani
Dr. Karishma Thariani

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Modification of layered technique in traumatic cloaca

Thariani, K1; Sharma, JB1; Kumari, R1; Kriplani, I2; Kriplani, A1

1: All India Institute of Medical Sciences; 2: AII India Institute of medical sciences

Introduction: Anal incontinence due to traumatic cloaca is an under reported problem which has grave effects on a woman’s psychological, social and physical wellbeing. In developing nations home births by unskilled birth attendants are the major cause for obstetric anal sphincter injuries leading to traumatic cloaca. Recognition of the deformity and its optimal repair needs skill and training. An optimal repair generally has good outcomes and greatly improves a woman’s quality of life.

Objective: Video presentation of a ‘modification of layered technique’ of repair of traumatic cloaca and to evaluate its outcomes.

Methods: This was a retrospective longitudinal analysis of 12 patients of cloacal deformity who underwent repair of cloacal deformity using a modification of layered technique from January 2017 to May 2017. Data regarding age, BMI, parity, mode of delivery, duration, nature of symptoms and pre- operative Wexner scores were noted. Details of intra operative complications, duration of surgery, blood loss and post-operative stay were recorded. All the Patients were followed up at 3 months and 6 months. Wexner scores at 6 months were noted along with any other complaints.

Results: Mean age and parity of the patients was 35± 11.2 yrs and 2.54± 1.5. Obstetric anal sphincter injury was the chief cause of traumatic cloaca in 11/12 (91.6%) patients, all of which were vaginal deliveries. In one patient the cause was sexual assault in childhood. 5/11(45.4%) patients had home deliveries conducted by traditional birth attendants. 4/12(33.3%) patients had previous failed repairs. Mean duration of surgery was 90 mins and median blood loss was 150 ml. There were no major intra operative or post-operative complications. Mean follow up time was 6 months. Cure rate at end of 6 months was 90%. There was a significant reduction in Wexner scores (p value 0.00) at the end of 6 months. One patient developed a small rectovaginal fistula with complaints of passage of air through vagina but was continent for liquid and solid stool.

Conclusion: This modification of layered technique is shown to be an effective and safe procedure.


Work supported by industry: no.

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