Work

Perineal Body Reconstruction for Anal Sphincter Insufficiency Following Obstetric Perineal Body Injury: Morphology-based Classification and Type-stratified Outcomes in 42 Cases

Year: 2026

Type: article

Abstract: Objectives: Post-obstetric fecal incontinence is multifactorial, and structural aspects related to the perineal body may not be fully characterized within current frameworks. We propose a three-type morphology-based classification and report type-stratified outcomes after perineal body reconstruction, in which the lateral extensions of the perineal body (LEPB) are reapproximated without direct sphincter manipulation. Methods: Forty-two consecutive female patients (July 2022-December 2025) with post-obstetric anal sphincter insufficiency (Wexner ≥ 4) underwent perineal body reconstruction and were classified as Type 1 (rectovaginal fistula, n = 20), Type 2 (sphincter insufficiency without fistula, n = 14), or Type 3 (cloaca-like deformity, n = 8). The primary outcome was the 6-month change in Wexner score; clinical improvement was defined as a decrease ≥ 4 points. Post-operative scores were compared by Kruskal-Wallis and post-hoc Mann-Whitney U tests with Bonferroni correction (adjusted α = 0.0167). Results: The overall Wexner score decreased from 11.4 ± 4.7 to 3.4 ± 4.3 (p < 0.001, Cohen's d = 1.92), with a 95.2% clinical improvement rate (40/42) and 50.0% complete remission (21/42). Post-operative scores differed among types (Kruskal-Wallis, p = 0.010); after Bonferroni correction, only Type 1 vs Type 2 remained significant (raw p = 0.003; adjusted p = 0.009). Type 1, 2, and 3 improvement rates were 100%, 85.7%, and 100%. Conclusions: The morphology-based classification linked preoperative assessment to type-specific surgical considerations and outcome expectations. Perineal body reconstruction, which targets the connective-tissue scaffold rather than the sphincter muscle, may complement muscle-level sphincteroplasty and neuromodulation; prospective comparative evaluation is warranted.

Source: Journal of the Anus Rectum and Colon

DOI: 10.23922/jarc.2026-039

Authors: Koichiro Murakami, Yumi Nishimura, Tomoyuki Mizukuro

Institution: Shiga University of Medical Science

Language: English

Topic: Pelvic floor disorders treatments

Subfield: Urology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,507