Posterior Perineal Techniques

Abstract

Although the anterior rectal wall, rectovaginal septum and perineal body are prime areas of local weakness of the anorectal organ associated with incontinence and prolapse, posterior perineal procedures have always been popular when surgical correction has been attempted. From the earliest descriptions of Lange (1887) [8], Tuttle (1903) [13] and Lockhart-Mummery (1910) [9] up to the present day, many surgeons have employed the posterior approach as the method of choice for a perineal fixation of the rectum. One such repair [the post-anal (Parks) operation] [10] demands a high level of familiarity with the sphincteric anatomy. However, most surgeons are familiar with the dissection via the perineum of the tissues in the plane between the lower rectum and the front of the coccyx and sacrum as a part of their training for the abdomino-perineal (Miles) operation of cancers of the lower third of the rectum; this route can also be adapted for fixation of rectal prolapse and repair of the external anal sphincter, as in the Wyatt technique (pp.70–77)