# Practical use of transanal decompression tube following the repair of fourth-degree perineal tears associated with vaginal delivery

## TL;DR

A transanal decompression tube helps reduce complications after repairing severe perineal tears from vaginal delivery.

## Contribution

A practical method using a transanal decompression tube is proposed to improve outcomes in fourth-degree perineal tear repair.

## Key findings

- Five patients had successful repair with no fistula or incontinence.
- Transanal decompression tube placement reduced anastomotic leakage risks.
- Gastrografin enema and CT scans confirmed safety before tube removal.

## Abstract

Fourth-degree perineal tears associated with vaginal delivery (PTAVD) occur in approximately 0.25 to 6% of vaginal deliveries. A persistent challenge in treating fourth-degree PTAVD is the high incidence of anastomotic leakage, leading to impaired quality of life, marked by incontinence, rectovaginal fistula, and painful sexual intercourse. Thus, effective interventions are necessary. Herein, we report our successful approach in repairing a fourth-degree PTAVD, involving the placement of a transanal decompression tube (TDT) during the early postoperative period.

Five patients underwent the repair of fourth-degree PTAVD by suturing the mucosal and muscular layers of the rectum, and the vaginal wall in layers. Subsequently, a TDT was placed in the rectum, positioned 10–15 cm from the anal verge. The TDT was allowed to drain spontaneously without suction. Gastrografin enema examination was performed through a TDT, followed by a computed tomographic scan on postoperative days 3–4. After unfavorable complications were ruled out, the TDT was removed and the patients were transitioned to a normal diet.

All patients showed favorable outcomes with no occurrence of vaginal fistula or incontinence.

This simple intervention demonstrates potential efficacy in reducing anastomotic leakage following the repair of fourth-degree PTAVD.