Perineal Body Reconstruction for Anal Sphincter Insufficiency Following Obstetric Perineal Body Injury: Morphology-based Classification and Type-stratified Outcomes in 42 Cases.
- 1Department of Surgery, Soshinkai Nagaokakyo Hospital, Nagaokakyo, Japan.
- 2Department of Digestive and General Surgery, Shiga University of Medical Science, Otsu, Japan.
Abstract
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. 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). 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%. 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.
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BibTeX
@article{murakami2026perineal,
title = {{Perineal Body Reconstruction for Anal Sphincter Insufficiency Following Obstetric Perineal Body Injury: Morphology-based Classification and Type-stratified Outcomes in 42 Cases.}},
author = {Koichiro Murakami and Yumi Nishimura and Tomoyuki Mizukuro},
journal = {Journal of the anus, rectum and colon},
year = {2026},
month = oct,
doi = {10.23922/jarc.2026-039},
url = {https://europepmc.org/article/MED/42952902},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Perineal Body Reconstruction for Anal Sphincter Insufficiency Following Obstetric Perineal Body Injury: Morphology-based Classification and Type-stratified Outcomes in 42 Cases.
AU - Koichiro Murakami
AU - Yumi Nishimura
AU - Tomoyuki Mizukuro
PY - 2026
DA - 2026/10/25
JO - Journal of the anus, rectum and colon
DO - 10.23922/jarc.2026-039
UR - https://europepmc.org/article/MED/42952902
AB - 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. 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). 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%. 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.
SN - 2432-3853
ER -