slicing vs. cutting the sacrotuberous ligament

[April]

Hi Everyone,

I have decided to go ahead with decompression surgery, but I’m not sure if I should do it with Dr. Hibner or Dr. Conway. They both do the transgluteal surgery, but Conway slices the sacrotuberous ligament and Hibner cuts it. Slicing does less damage to the ligament (Conway said it is like separating the strings on a violin), but (according to Hibner) it gives the surgeon less visibility than cutting it. In fact, Hibner said his cutting approach gives the surgeon “significantly more visualization” than the slicing approach. I didn’t get a description of the cutting approach (so if someone has that info, I’d be interested). I thought cutting meant cutting it in half (the short way) and pulling the ligament back on each side, but I just did a search and found an entry where the “windowing” approach (which may be the same as cutting) is described as cutting out a rectangular shaped area, which sounds awful. But, Hibner said that when he’s done a second surgery on patients that had that their ligaments cut, the severed ligament looks just like the other one. He also said that his physical therapist has said the severed ligaments feel to her just like unsevered ligaments once they have healed. So, that is encouraging. My top priority with the surgery is to have a successful decompression, so I’m leaning toward Hibner, given that it seems like it would increase the odds of successfully decompressing the nerve. On the other hand, Hibner said my MRI suggests the compression is in a place that is easy to get to (in between the ST and SS ligaments), so maybe that extra visibility isn’t needed. So, I’m wondering if anyone has any thoughts on this. Have you had one or the other surgeries? And if so, how is your ST ligament? Did the surgery reduce your pn pain?

Many thanks,
April

[Violet M]

A team including Dr. Dellon recently published an article showing that the ligament heals back even if it is severed.
http://www.pudendalhope.info/forum/view ... =23&t=8275

Wishing you all the best, whatever you decide.

Violet

[April]

Thank you, Violet! I thought I remembered seeing a study on here about this. That is reassuring. The study compares STLs that were "divided" (some grafted and some not grafted) to uncut ligaments. I wonder if dividing is slicing or windowing. I'll read the article and post the info. But, either way, it is reassuring to see these results.

April

[April]

The article doesn't indicate if dividing means slicing or windowing. It may be a general term that includes both procedures. Either way, it is reassuring to see that the ligament heals without grafting.

April

[Violet M]

I guess I just assumed dividing meant completely severing the STL because in my mind there wouldn't be any reason to compare a grafted ligament to one that wasn't severed. I just understood them to be comparing a grafted ligament to one that was cut apart. The dictionary definition for divide is to separate into parts so I think that would mean dividing the ligament into two parts, not just slicing a cut in it that still leaves it intact.

Violet

[April]

Oh, yes, that makes sense. That's great then. It makes the findings even more powerful if those ligaments that healed so well were fully severed. Thanks, Violet.

April