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Transverse Perineal Support: A Novel Surgical Treatment for Perineal Descent in Patients With Obstructed Defecation Syndrome

Renzi, Adolfo M.D., Ph.D.; Brillantino, Antonio M.D., Ph.D.; Di Sarno, Giandomenico M.D.; d’Aniello, Francesco M.D.; Bianco, Pasquale M.D.; Iacobellis, Francesca M.D.; Reginelli, Alfonso M.D., Ph.D.; Grassi, Roberto M.D.

Diseases of the Colon & Rectum: June 2016 - Volume 59 - Issue 6 - p 557–564
doi: 10.1097/DCR.0000000000000573
Original Contributions: Pelvic Floor
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BACKGROUND: We hypothesized that pathological perineal descent may be responsible for the failure of operations for obstructed defecation syndrome and that correcting excessive perineal descent may improve the outcome in this group of patients.

OBJECTIVE: The purpose of this study was to report the short-term preliminary results of a novel surgical procedure, transverse perineal support, for the correction of pathological perineal descent.

DESIGN: This was a prospective, uncontrolled, open-label study.

SETTINGS: The study was conducted in a hospital and a university center.

PATIENTS: Among 25 patients observed with failure of previous surgery for obstructed defecation syndrome, 12 with pathological perineal descent underwent transverse perineal support, were followed-up at 6 months, and constituted the object of analysis.

INTERVENTIONS: The surgical procedure was performed positioning a porcine dermal implant just above the perineum superficial fascia sutured to the periosteum membrane of ischiatic tuberosities at the insertion of the superficial transverse perineal muscle.

MAIN OUTCOME MEASURES: The main outcome measures were obstructed defecation syndrome score and x-ray and magnetic resonance defecographic imaging evaluation of perineal descent and anorectal manometric parameters.

RESULTS: The postoperative median obstructed defecation syndrome score was 7.0 (range, 3–8), showing a statistically significant difference if compared with the preoperative score of 13.5 (range, 9–18; p = 0.0005). The mean postoperative maximum intrarectal pressure was 69.4 ± 11.1 mm Hg, significantly higher than the preoperative pressure of 45.9 ± 12.8 mm Hg (p < 0.0001). At postoperative x-ray and magnetic resonance imaging defecography, the mean fixed and dynamic perineal descents were significantly lower than the preoperative descents (p = 0.02 for fixed perineal descent and p = 0.0004 for dynamic perineal descent). Of the 4 patients (33.3%) with preoperative pathological dynamic perineal descent, only 1 showed a persistent pathological dynamic perineal descent. No early or late complication was observed.

LIMITATIONS: The study was limited by its small size and short follow-up time.

CONCLUSIONS: Transverse perineal support appears to be a promising, safe, and effective procedure in the treatment of obstructed defecation syndrome associated with pathological perineal descent (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A225).

Supplemental Digital Content is available in the text.

1 Pelvic Care Center, “Villa delle Querce” Hospital, Naples, Italy

2 “A. Cardarelli” Hospital, Naples, Italy

3 Department of Radiology, Second University of Naples, Naples, Italy

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Financial Disclosure: None reported.

Correspondence: Adolfo Renzi, M.D., Ph.D., Pelvic Care Center, “Villa delle Querce” Hospital, via Battistello Caracciolo 48, 80136 Naples, Italy. E-mail: ar@colonproctologia.eu

© 2016 The American Society of Colon and Rectal Surgeons