ENDOSCOPIC PUDENDAL CANAL DECOMPRESSION FOR THE TREATMENT OF FECAL INCONTINENCE DUE TO PUDENDAL CANAL SYNDROME

Fecal incontinence resulting from pudendal canal syndrome has been tre ated by pudendal canal decompression (PCD) with satisfactory results. Considering the possible difficulty in exposing the pudendal canal and nerve by the open method, laparoscopic PCD was practiced in 9 women a ged between 37 and 52 years. They were complaining of fecal incontinen ce; urinary stress incontinence was an additional complaint in 4/9 wom en. Neurologic, manometric, and EMG studies confirmed the diagnosis of pudendal canal syndrome. For laparoscopic PCD a 1-cm incision lateral to the anal orifice was performed. A balloon dilator was introduced i n the ischiorectal fossa (IRF) to create a working space, and CO2 was insufflated. Under the guidance of a laparoscope, the IRF was entered and the inferior rectal nerve identified and followed to the pudendal canal. The latter was split open, releasing the pudendal nerve into th e IRF. Fecal control was achieved in 7/9 patients and urinary control in 2/4. Fecal and urinary control were associated with improvement in perianal sensation, rectal neck pressure, EMG of external anal sphinct er and levator ani muscle as well as in pudendal nerve terminal motor latency. Two women showed no improvement. Failure is suggested to be d ue to an advanced pudendal neuropathy. In conclusion, laparoscopic PCD is a simple, easy, and safe procedure. It allows for better exposure of the contents of the IRF than the open procedure, thus avoiding inju ry of the pudendal nerve and its branches during the performance of th e PCD.