Akatov O.V., Dreval O.N.
(Russian Medical Academy of Postgraduate Education, Moscow, Russia)
Pain in an anal-coccygeal area is usually caused by sustained trauma or local inflammatory processes. A disease manifests itself as a complex, combining pathologic changes in the sacrococcygeal articulation and spasticity of muscles of the pelvic bottom. Conventional methods of treatment, including surgical interventions on muscles and the cocccygeal bone resection give a good result only in 27% of cases.
A new method of surgical treatment is aimed at interruption of pain impulses. It lies in transcutaneous radio-frequency destruction of articular nerves of the sacrococcygeal articulation and muscles of the pelvic bottom in an area of their fixing to the sacrum and coccygeal bone.
The operation was performed under local anesthesia in an X-ray operating room with use of TIC radio-frequency electrodes (Radionics) and stiletto needles of original design. A radio-frequency electrode was inserted transcutaneously in projection of articular nerves of the sacrococcygeal articulation, iliosacral articulations, inferiorsacral nerves and places of fixing of m. levator ani to the sacrum and coccygeal bone. Destruction was carried out in every point at 80oC and an exposure of 120 seconds.
Our new method, having almost no contraindications, was used in 10 patients (3 males and 7 females, aged 21-56). Before it these patients had been treated during many years by different specialists, including psychiatrists. They had underwent sphincterotomy, anus divulsion, levarotomy, resection of the coccygeal bone (2 cases), discal hernia removal (1 patient). A stable analgesic effect was achieved after our operation in 6 patients. A period of follow-up was equal to 2 years.