title: Transverse Perineal Support: A Novel Surgical Treatment for Perineal Descent in Patients With Obstructed Defecation Syndrome.
abstract: 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.
  
  
  METHODS
  This was a prospective, uncontrolled, open-label study.
  
  
  METHODS
  The study was conducted in a hospital and a university center.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: 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.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Renzi
authors.forename: Antonio
authors.initials: A
authors.lastname: Brillantino
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Di Sarno
authors.forename: Francesco
authors.initials: F
authors.lastname: d'Aniello
authors.forename: Pasquale
authors.initials: P
authors.lastname: Bianco
authors.forename: Francesca
authors.initials: F
authors.lastname: Iacobellis
authors.forename: Alfonso
authors.initials: A
authors.lastname: Reginelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Grassi
mesh_terms: D000328:Adult; D000368:Aged; D003094:Collagen / Q000627:therapeutic use; D003248:Constipation / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000150:complications / Q000601:surgery*; D010502:Perineum / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: C422414:Permacol; D003094:Collagen