Health Organization for Pudendal Education

Hi Gregg,
Dr. Beco in Belgium does the Trans-perenial approach but he does sever the Sacospinous ligament now.Ask Dr. Marvel if he can access the whole of the Alcock's Canal and whether he is severing the Sacrospinous ligament.
Your best bet is Dr. Bautrant' TIR when it comes to the Alcock''s Canal because he can remove any scar tissue there,and Especially in men because that's where he makes the incision.Dr. Mark Conway does the TIR approach but his results haven't been so promising.It is better to go Dr. Bautrant himself to have the TIR approach done if you are interested.


As far as the TG approach concerned, it is of three types now.

1)The traditional TG approach used by Professor Robert of Nantes and the Houston team in which both the Sacrotuberous and Sacrospinous ligament is severed.

2)Modified Approach by Dr. Hibner in which the Sacrotuberous ligament is 30-50% severed at the vertical axis but then repaired with grafted Cadavers.The Sacrospinous ligament is severed.

3)Modified approach by Dr. Antalok in which the Sacrotuberous ligament is vertically cut in the middle and then sewed back but the Sacrospinous ligament is severed.Karyn can help you out more regarding this since she is going to have this modified version with Dr. Conway.

The surgical results are poor in all three approaches mentioned
above and that what concerns the patient the most.
Hopefully,this is helpful.

Kind Regards,
Ali
1

Ali, I don't think you can say for sure which approach has the best or the poorest results. There really isn't enough data yet and may never be to say for sure. Even with a procedure as common as a hysterectomy my gyn told me that there isn't enough published data to say with certainty which approach is best. There are pros and cons with each approach and I think patients need to study the pros and cons of each and determine what they think is best for them. My understanding is that none of them address the inferior rectal branch very well yet.

Hi Violet,
Just like the dorsal nerve and the Perenial Nerve. What I mean is that we have poor results from PNE surgery as a whole.

Kind Regards,
Ali

Yes, I understand now Ali. I thought you were referring to the 3 types of TG surgery having poor results but I see now what you meant.

You are welcome.

Hi Ali, thank you as always for your help, insight, information, and explanation, you have been extremely helpful in giving me options, hope, and choices, you are an asset to this website, and we should all be grateful that you provide information for all of us as patients with a patient-centered approach as well as providing hope for us in the future. Most of all, thank you for the information that you give on ALL of the aspects of this surgery, including the potential cutting of the ligaments and what that could mean....a patient should be given ALL of the information up front before surgery so that we can make informed decisions.....you also help us form questions so that when we talk with our doctors we know the proper questions to ask...i am quite grateful, as a former athlete who has lost his ability to play sports, and as a guy who has been suffering with this for 19 months now, i thank you for your research, and time and effort into learning about each doctor, and the pros and cons of each of their surgical approaches, so that we the patient can make an informed decision with who we wish to go to for help! Keep up the great work, we are ALL grateful! P.S. my hip surgeon, dr nelson told me today that the ligaments in the pelvis are quite strong, but it is still a risk to sever the ligaments because they could cause pelvic instability, he said that it is hard to test ligamentous strength, its person to person, so one person may be ok, but another person could have their ligaments severed and have pelvic instability for life.

Gregg from Philly.

You are most welcome Gregg.Let's hope that we all get out of this awful mess soon and all options and risks should be explained to the patients especially before such an invasive surgery as PNE surgery.

Kind Regards,
Ali