title: Semi-closed bilateral partial miotomy of the puborectalis for anismus: a pilot study: Partial miotomy of the puborectalis for anismus.
abstract: BACKGROUND
  Anismus or non relaxing puborectalis muscle (PRM) may cause obstructed defecation (OD). Reported surgical treatment is partial miotomy, followed by sepsis, bleeding, and incontinence. The aim of the present study was to investigate on the feasibility and outcome of a modified mini-invasive operation.
  
  
  METHODS
  Consecutive patients with anismus and OD not responding to medical therapy, excluding multiparous females, patients with anal incontinence, recto-rectal intussusception, and disordered psychological pattern. Semi-closed bilateral partial division of PRM, pulled down through 1-cm perianal incisions, was performed. Concomitant significant rectal mucosal prolapse and rectocele, when present, were treated. OD was evaluated using a validated score and anal/vaginal ultrasound (US) was performed pre -and postoperatively. A control group of seven patients with normal bowel habit was also investigated.
  
  
  RESULTS
  Eight patients (seven females), median age 48 years (range 29-71) were operated. Six also had significant mucosal prolapse and rectocele. All were followed up for a median of 12 months (range 2-40). None of them had postoperative sepsis or bleeding. One had just one occasional episode of mild anal incontinence. Symptoms improved in 6 or 75 % and, OD score decreased from 19.6 ± 1.0 to 9.2 ± 2.0 (mean ± s.e.m.), P = 0.007. No patient had anismus after surgery and PRM relaxation changed from 0 to 5.9 ± 0.8 mm being 6.6 ± 1.5 mm in controls.
  
  
  CONCLUSIONS
  Semi-closed bilateral partial division of PRM achieves muscle's relaxation on straining in all patients without any significant postoperative complication. Further studies are needed prior to consider it a validated procedure.
authors.affiliation: Coloproctology Unit, Parioli Clinic, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Asciore
authors.affiliation: Coloproctology Unit, Parioli Clinic, Rome, Italy.
authors.forename: L C
authors.initials: LC
authors.lastname: Pescatori
authors.affiliation: Coloproctology Unit, Parioli Clinic, Rome, Italy. ucpclub@virgilio.it.
authors.forename: M
authors.initials: M
authors.lastname: Pescatori
mesh_terms: D000328:Adult; D000368:Aged; D001004:Anus Diseases / Q000150:complications / Q000601:surgery*; D003248:Constipation / Q000209:etiology / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D018482:Muscle, Skeletal / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Anismus; Constipation; Obstructed defecation; Puborectalis muscle