Introduction : This study prospectively evaluates a unique surgical procedure, Gore-Tex Perineal Sacral Suspension (GPSS), to relieve symptoms of obstructed defecation (OD). Methods: One surgeon evaluated and treated women with symptomatic OD. Women with complaints of hard, painful BM's, difficult evacuation, pelvic pain, and straining were evaluated with anal manometry, EMG, pudendal nerve latency, defecography, cystography, enterography and transit time. Women selected for operation had: significant symptoms, strong desire for relief, failed other therapies and anatomic defect on x-ray (anterior rectocele, enterocele or sigmoidocele). The operation included bilateral sacral rectopexy with Gore-Tex sutures to which a Gore-Tex strip was attached on each side. Perineal sacral suspension was performed using two #2 Prolene sutures passed through the pelvic floor from the pelvic cavity to the perineal skin and back with a single prong Cobb-Ragde needle. The sutures were placed via shallow transverse perineal skin incisions. Each suture passed on both sides of the midline. Tying the Prolene recreated a narrow pelvic inlet. Each Prolene suture was suspended to one Gore-Tex strip. A detailed symptom questionnaire was completed before and after GPSS at each visit and prospectively entered into a database. Statistical analysis with McNemar's test and Fisher's exact test were used and P<.05 were considered significant. Results: Between January 10, 2001 and September 1, 2005, 56 women underwent GPSS for OD in the absence of colonic inertia. There were no pelvic infections and no deaths. OD symptoms were significantly reduced post operatively (see table). After surgery 84% were satisfied, 16% neutral and none were unsatisfied. Mean follow-up was 8.8 months. Discussion: GPSS can be performed safely with significant reduction of OD symptoms and high patient satisfaction. It seems to narrow the muscular pelvic outlet, recreate a thicker rectovaginal septum and lift the perineum correcting perineal descent. It seems to be an effective surgical therapy for women suffering from perineal descent and associated symptoms of obstructed defecation.
Symptomatic Improvement Following GPSS