Clinical Outcomes of Transanal Drainage Tube Placement Following Surgical Repair for Chronic III-IV Perineal Tears

Wei Liu,1,* Xinmiao Bao,1,* Yiwei Zhang,1 Yaqian Li,1,2 Shu Wang,1 Hua Yang,1 Lan Zhu1 1Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Common Mechanism Research of Major Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China; 2Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lan Zhu, Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Common Mechanism Research of Major Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China, Tel +86-10-69155016, Email [email protected]: To evaluate the outcome and safety of transanal drainage tube (TDT) placement following surgical repair of chronic third- and fourth-degree perineal tears.Patients and Methods: A retrospective cohort study was conducted at Peking Union Medical College Hospital (2016– 2024), including 31 patients with chronic perineal tears who underwent surgical repair. Patients were stratified into success (n=23) and failure (n=8) groups. Surgical failure was defined as persistence of fecal incontinence at six months postoperatively. Data included demographics, surgical details, TDT use, Wexner, and SF-12 scores.Results: The procedure demonstrated an overall success rate of 74.2% (23/31). Postoperative SF-12 and Wexner scores improved significantly in both the success and failure groups (p < 0.05). The success group had longer tube retention (9[7– 11.5] vs 7[6– 7] days, p=0.03). Further analysis revealed that prolonged drainage duration beyond 8 days was associated with improved success rates. Patients in the TDT group showed significantly greater improvement in Wexner scores (11.42 ± 3.13 vs 7.67 ± 3.37, p = 0.004). No major TDT-related complications occurred.Conclusion: Transanal drainage tube placement may enhance anal sphincter function when used at the time of anal sphincteroplasty. Maintaining TDT for more than 8 days is associated with higher success rate. Both successful and unsuccessful repairs lead to significant improvements in quality of life and fecal incontinence symptoms.Plain Language Summary: TDT after surgical repair for chronic perineal tears may improve anal function and quality of life; retaining TDT over 8 days is associated with higher success rate without major complications.Keywords: chronic perineal tears, fecal incontinence, SF-12 score, transanal drainage tube, Wexner score