Compliments of the Author. 
A 
MODIFICATION IN THE TECHNIQUE OF OPERATIONS 
FOR THE 
REPAIR OF COMPLETE PERINEAL LACERATIONS. 
BY 
WM. B. VAN LENNEP, A.M., M.D., 
PHILADELPHIA. 
Reprinted from the Hahnemannian Monthly, March, 1892. A 
MODIFICATION IN THE TECHNIQUE OF OPERATIONS 
FOR THE 
REPAIR OF COMPLETE PERINEAL LACERATIONS 
BY 
WILLIAM B. VAN LENNEP, A.M., M.D., 
PHILADELPHIA. 
My experience has been, and I think I reiterate that of most 
operators, that the principal cause of failure after plastic operations 
to restore the perineal body when the sphincters and the rectum are 
torn, is infection through the wound sutures in the gut. If this 
element of danger could be eliminated, the operation would 
be reduced to the correction of an incomplete tear, plus finding and 
uniting the ends of the sphincters. This danger was impressed upon 
me very forcibly by a partial failure, a case in which the ends of the 
sphincter united, but a leak appeared above, producing a sinus which 
opened on the external surface of the perinaeum. Faecal leakage 
persisted for a long time, and the integrity of the perineal body was 
considerably impaired. 
With this case fresh in my mind, I was called upon about a year 
ago to repair a very bad tear, the worst one I have ever met with, 
which completely destroyed the perineal body, extended up the 
vagina, almost reaching the cervix, with prolapse of the rectal 
mucosa at a point well up, and went through both the rectal sphinc- 
ters and about two inches of the bowel. There was such inconti- 
nence of faeces that the patient was unable to walk about without 
soiling herself, and with this was associated a complete prolapse of 
the uterus. Remembering the ease with which the rectal mucous 
membrane can be drawn down after resecting "the pile-bearing 
inch" in Pratt's operation, it occurred to me that I could use this 2 
as a septum to positively shut off any wound infection from the bowe] 
side. The rectal mucous membrane was accordingly loosened by an 
incision with scissors along the triangle running up the bowel, its 
edges seized with T-forceps, easily drawn down and held well over 
the anus by the mere weight of the instruments. There remained 
then but the ordinary operation for a complete tear minus the stitches 
tied into the rectum. The edges of the rectal triangle were freshened 
and united by buried sutures of catgut; the torn ends of the sphinc- 
ter were exposed and brought together in like manner; the oblique 
cicatrix was dissected out and the gap sutured (posterior colporha- 
phy), and a new perineal body formed by the flap-splitting method. 
Of course, the two halves of the Hap had to be united in the centre 
within the vagina. 
The perineoraphy completed, the T-forceps were removed, and the 
drawn-down rectal mucous membrane was allowed to retract and 
stitched to the anterior or new half of the anus. The result has been 
perfectly satisfactory ; the uterus is supported ; there is a good, firm 
perinaeum, and the sphincter is completely restored. 
I have since had two opportunities of testing this operation with 
very satisfactory results.