Skip to main content

Advertisement

SpringerLink
Log in

Semi-closed bilateral partial miotomy of the puborectalis for anismus: a pilot study

Partial miotomy of the puborectalis for anismus

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

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.

Patients and 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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Pescatori M, Spyrou M, Pulvirenti d’Urso A (2006) A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’. Colorectal Dis 8:785–789

    Article  CAS  PubMed  Google Scholar 

  2. Vermeulen J, Lange JF, Sikkenk AC, van der Harst E (2005) Anterolateral rectopexy for correction of rectoceles leads to good anatomical but poor functional results. Tech Coloproctol 9:35–41

    Article  CAS  PubMed  Google Scholar 

  3. Pucciani F, Iozzi L, Masi A, Cianchi F, Cortesini C (2003) Multimodal rehabilitation for faecal incontinence: experience of an Italian centre devoted to faecal disorder rehabilitation. Tech Coloproctol 7:139–147

    Article  CAS  PubMed  Google Scholar 

  4. Farid M, Youssef T, Mahdy T, Omar W, Moneim HA, El Nakeeb A, Youssef M (2009) Comparative study between botulinum toxin injection and partial division of puborectalis for treating anismus. Int J Colorectal Dis 24:327–334

    Article  PubMed  Google Scholar 

  5. Farid M, El Nakeeb A, Youssef M, Omar W, El Monem HA (2010) Comparative study between surgical and non-surgical treatment of anismus in patients with symptoms of obstructed defecation: a prospective randomized study. J Gastrointest Surg 14:1235–1243

    Article  Google Scholar 

  6. Miliacca C, Gagliardi G, Pescatori M (2010) The ‘Draw-the-Family Test’ in the preoperative assessment of patients with anorectal diseases and psychological distress: a prospective controlled study. Colorectal Dis 12:792–798

    Article  CAS  PubMed  Google Scholar 

  7. Brusciano L, Limongelli P, Pescatori M et al (2007) Ultrasonographic patterns in patients with obstructed defaecation. Int J Colorectal Dis 22:969–977

    Article  CAS  PubMed  Google Scholar 

  8. Pescatori M (2009) Long-term follow-up of simultaneous abdominoperineal repair of enterorectocele and internal mucosal prolapse. Dis Colon Rectum 52:327–335

    Article  PubMed  Google Scholar 

  9. Aigner F, Gruber H (2008) Two-dimensional ultrasonography of pelvic floor and anorectal anatomy. In: Imaging atlas of the pelvic floor and anorectal diseases, pp:3–8. Pescatori M, Regadas FSP, Murad Regadas SM, ZbarAP. Eds. Springer-Verlag

  10. Pescatori M, Quondamcarlo C (1999) A new grading of rectal internal mucosal prolapse and its correlation with diagnosis and treatment. Int J Colorectal Dis 14:245–249

    Article  CAS  PubMed  Google Scholar 

  11. Block IR (1986) Transrectal repair of rectocele using obliterative suture. Dis Colon Rectum 29:707–711

    Article  CAS  PubMed  Google Scholar 

  12. Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10:84–88

    CAS  PubMed  Google Scholar 

  13. Pescatori M, Anastasio G, Bottini C, Mentasti A (1992) New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum 35:482–487

    Article  CAS  PubMed  Google Scholar 

  14. Marcio J, Jorge N, Wexner SD (1993) Etiology and management of faecal incontinence. Dis Colon Rectum 36:77–97

  15. Pescatori M, Boffi F, Russo A, Zbar AP (2006) Complications and recurrence after excision of rectal internal mucosal prolapse for obstructed defaecation. Int J Colorectal Dis 21:160–165

    Article  CAS  PubMed  Google Scholar 

  16. Brown AJ, Anderson JH, McKee RF, Finlay IG (2004) Surgery for occult rectal prolapse. Colorectal Dis 6:176–179

    Article  CAS  PubMed  Google Scholar 

  17. Roman H, Michot F (2005) Long-term outcomes of transanal rectocele repair. Dis Colon Rectum 48:510–517

    Article  PubMed  Google Scholar 

  18. Maria G, Sganga G, Civello IM, Brisinda G (2002) Botulinum neurotoxin and other treatments for fissure-in-ano and pelvic floor disorders. Br J Surg 89:950–961

    Article  CAS  PubMed  Google Scholar 

  19. Wasserman IF (1964) Puborectalis syndrome (rectal stenosis due to anorectal spasm). Dis Colon Rectum 7:87–98

    Article  CAS  PubMed  Google Scholar 

  20. Barnes PR, Hawley PR, Preston DM, Lennard-Jones JE (1985) Experience of posterior division of the puborectalis muscle in the management of chronic constipation. Br J Surg 72:475–477

    Article  CAS  PubMed  Google Scholar 

  21. Altomare DF, Rinaldi M, Rubini D et al (2007) Long-term functional assessment of antegrade colonic enema for combined incontinence and constipation using a modified Marsh and Kiff technique. Dis Colon Rectum 50:1023–1031

    Article  PubMed  Google Scholar 

  22. Boccasanta P, Venturi M, Stuto A et al (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296, discussion 1296–1297

    Article  PubMed  Google Scholar 

  23. Gagliardi G, Pescatori M, Altomare DF et al (2008) Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum 51:186–195

    Article  PubMed  Google Scholar 

  24. Bassi R, Rademacher J, Savoia A (2006) Rectovaginal fistula after STARR procedure complicated by haematoma of the posterior vaginal wall: report of a case. Tech Coloproctol 10:361–363

    Article  CAS  PubMed  Google Scholar 

  25. Madbouly KM, Abbas KS, Hussein AM (2010) Disappointing long-term outcomes after stapled transanal rectal resection for obstructed defecation. World J Surg 34:2191–2196

    Article  PubMed  Google Scholar 

  26. Lenisa L, Schwandner O, Stuto A et al (2009) STARR with contour Transtar: prospective multicentre European study. Colorectal Dis 11:821–827

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Coloproctology Unit, Parioli Clinic, Rome, Italy

    L. Asciore, L. C. Pescatori & M. Pescatori

Authors
  1. L. Asciore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. C. Pescatori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Pescatori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Pescatori.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Asciore, L., Pescatori, L.C. & Pescatori, M. Semi-closed bilateral partial miotomy of the puborectalis for anismus: a pilot study. Int J Colorectal Dis 30, 1729–1734 (2015). https://doi.org/10.1007/s00384-015-2330-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-015-2330-7

Keywords

Search

Navigation