title: Perineorrhaphy: commonly performed yet poorly understood. A survey of surgeons.
abstract: OBJECTIVE
  Perineorrhaphy is performed for the prevention of recurrent prolapse, improved sexual function, treatment of pain, and cosmesis. Its use is based on expert opinion with few objective data. We aimed to describe factors that are important to surgeons when deciding to perform perineorrhaphy and variations in surgical technique.
  
  
  METHODS
  We administered an anonymous survey to surgeon attendees at the 2014 SGS annual scientific meeting regarding which factors are important when deciding to perform a perineorrhaphy and details of their surgical technique. Surgeons rated the importance of factors; one-way ANOVA was used to rank the decision factors and post hoc pairwise comparisons with Fisher's least significant difference method were used to evaluate the importance between factors.
  
  
  RESULTS
  A total of 183 out of 360 surgeon attendees responded. Most were between ages 36 and 60 (79 %), 56 % were female, 64 % practiced in an academic environment, and 64 % had undergone subspecialty training. An enlarged genital hiatus (GH) ranked as the most important factor influencing the decision to perform a perineorrhaphy, followed by a concomitant prolapse procedure (p < 0.001). Sexual function and cosmesis were rated as being less important. The decision to perform perineorrhaphy was made with the patient in 65 % of cases, and otherwise in the operating room. Significant heterogeneity exists regarding surgeon suture preference and how muscles were re-approximated. Most (81 %) reported incorporating structures both proximal and distal to the hymen in their repairs.
  
  
  CONCLUSIONS
  Genital hiatus size and concomitant prolapse procedures ranked highest in surgeons' decision to perform a perineorrhaphy. Significant heterogeneity exists in the indications for and technique used to perform perineorrhaphy.
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico, MSC 10-5580, Albuquerque, NM, 87131-0001, USA. gkanter@salud.unm.edu.
authors.forename: Gregory
authors.initials: G
authors.lastname: Kanter
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico, MSC 10-5580, Albuquerque, NM, 87131-0001, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Jeppson
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico, MSC 10-5580, Albuquerque, NM, 87131-0001, USA.
authors.forename: Brenna Lynn
authors.initials: BL
authors.lastname: McGuire
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico, MSC 10-5580, Albuquerque, NM, 87131-0001, USA.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Rogers
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D005260:Female; D006176:Gynecology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D056887:Pelvic Organ Prolapse / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010502:Perineum / Q000601:surgery*; D010818:Practice Patterns, Physicians'
keywords: Perineoplasty; Perineorrhaphy