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Re: Episiotomy questionFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Sun Feb 17 12:43:24 2008
At Sun, 17 Feb 2008, Douglas Krell wrote: > >I think the success of the repair is proportional to the extent of the injury and the >ability of the surgeon to adequately understand and identify the anatomical features >and reconstruct them carefully. I've seen some surgeons that would have trouble putting a >a peanut butter and jelly sandwich together, let alone a perfectly cut proctoepisiotomy. I could not agree more Douglass, but there is still a big difference between anal sphincter and rectal sphincter, once you are into the rectal sphincter you are into the doo doo. I have repaired great big gapping blown out perineums when they get referred to me 3 months after birth, and the patients always feel they are better after the repair(basically perineum and anal sphincter shot but no rectal invovlement). When I get a rectal-vaginal fistula these days I refer them to the local colorectal surgeon , many patients are surprised when I tell them they may need a diverting colostomy, once they have heard it from a few other specialists they begin to realize that its serious.
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Take care, John
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