TG vs. TIR approach question ...

[Karyn]

Hi,
I'm hoping someone can clarify something for me. I recently heard that when one has surgery via the TIR approach, that your internal organs are moved (bowels, specifically) to gain access to the nerve. Is this true? Is the bladder moved to the side as well? Are your internal organs moved around via the TG approach?
Best regards,
Karyn

[Celeste]

Karyn, what I've heard about the TIR is they have to move your rectum out of its normal central position, and that the first time you have a bowel movement post op is very painful. I don't know about any of the other organs, though. Considering that they are going in through the front center of you, they will be close to the bladder and uterus, etc.

With the TG, they cut through skin and then the butt muscle (gluteus max) and then the next thing they come to is the ST ligament. So, it takes them directly to the area they will be working on.

[AliPasha1]

Hi,
I had TIR approach with Dr. Bautrant in Febuary,2010 and I am a male.My incision about made near the ischial tuberosity(sitting bone).He uses retractors to keep the rectum opening and access through the edge of the ani levator muscle which gives him access to the Alcock's canal.There is no problem with the bowel movements.The only thing is you might feel burning in the rectal area because the Pudendal nerve passes through there and it is traumatized after surgery.

Take care,
Ali

[GraceUnderFire]

I had TIR approach with Dr. Conway. My rectum was moved, but I had no issue with bowel movements as far as pain. I do take Miralax everyday as the neurontin and imipramine constipate me, but I did not have any bowel issues related to the surgery. I guess this is another one of those areas where folks are all different and have different experiences.

[Celeste]

Interesting; the first people who had surgery via TIR with Bautrant ALL remarked on their rectal issues post op, especially the men. Unfortunately I can no longer access those posts to review them. Very glad you two did not experience this, however I am sorry that you did not get relief from TIR surgery. That still seems to be a common issue.

[AliPasha1]

The reason is obvious.I am still entrapped in the Sacrotuberous ligament on my surgical side and in the Alcock's canal on the right side as shown by Dr. Potter's MRI.Secondly,most people have known for a long time that TIR approach cannot access the Sacrotuberous ligament if the nerve is entrapped there.

Best Regards,
Ali

[AliPasha1]

I think Dr. Potter's MRI also found that Grace is also entrapped in the ligaments.Please correct me if I am wrong.

[Karyn]

Well, one might think from reading Dr. Potters report that I'm a perfect candidate for the TIR approach. I previously posted her Summary under "MRI RESULTS" but here's what her front page said, "There is no angulation of the coccyx in the oblique axial or saggittal planes. There is no impingement on the branch of the pudendal nerve to the rectum. The pudendal nerves at the scacrotuberous ligaments are unremarkable. The posterior margin of Alcock's Canal is unremarkable. In the anterior margin of Alcock's Canal, there is pelvic floor scarring extending to the perivaginal fat planes. There is focal scar encasements of both pudendal nerves, left greater than right. Scar does extend to the posterior margin of the pubic symphis. There is scar surrounding both dorsal nerves to the clitoris. The fat planes around the rectum are perserved. There are no fluid collections or inflammatory soft tissue masses. There is no regional adenopathy. There is no occult fracture or osteonecrosis. Disc degeneration is noted in the lower lumbar spine. Signal characteristics and fat planes around the obturator nerves are preserved bilaterally. There is mild adductor tendinosis without tear. Ther fat planes around the ilioingual nerves are intact bilaterally".
I know it's fruitless, but I wish I could pull up older posts from pudendal.info. One of the first things I'd grab are Wendy's posts. If you're out there, Wendy, thank you so very much for sharing your story with all of us! But I think I remember her describing her surgery with Dr. Hibner, assisted by Dr. Conway. and an issue of scar tissue coming up. I remember something about Dr. Hibner being surprised about the extent of it and Dr. Conway being adament that it wasn't due to his surgery. I can't back myself up on this, but I also remember others who have (sadly) had to have undergone another surgery and the vast amount of scar tissues was mentioned, in the Alcock's canal.
There were a few reasons for my inquiry:TG vs. TIR. One of them I spelled right out. But another reason is, I'm concerned that the TIR approach causes additional scarring, either retrapping or entrapping the nerve. I don't think I've heard of anyone having TIR and having the nerves wrapped. I'd appreciate any input on this.
Warm regards,
Karyn

[AliPasha1]

Hi Karyn,
Wendy was also entrapped in the sacrotuberous ligaments.Plus,Dr. Potter MRI report says that I got re-entrapped in the scar tissue in the Alcock's canal in addition to the entrapment in the Sacrotuberous ligament on the surgical side.Secondly,I am still entrapped in the Alcock's canal on the non-surgical right side.

If you do consider TIR approach,then Dr. Bautrant is still the best option.But to be safe,Dr. Hibner is the best choice available in my opinion as far as TG is concerned.I will send you Dr. Hibner's presentation if you want to pm me your email.

Best Regards,
Ali

[Karyn]

Hi Ali,
Thanks so much for your support! I want to make it very clear at this time that I'm not even remotely considering the TIR approach. I know it was successful for some people, but I'm personally very uncomfortable with the approach. Dr. Hibner does indeed sound like the most successful surgeon at this time but I honestly have to say that I'm uncomfortable with his protocol. Or more accurately, with his current protocol. I admire Dr. Hibner for seeming to look for better ways to effectively treat his patients, but I have a hard time swallowing that some people have reported that he relies heavily on the patients history, yet now has a strict protocol (Botox, meeting with HIS PT, etc...) that, from what I got from it, was non-negiotiable. Maybe I got the wrong impression. I stand to be corrected. But I think AthenasMommy is a good example of that. I understand she's trying to do all the right things and I sincerely hope the botox injections benefit her. I also understand the faith she needs to feel in this person for such an life-altering, important decision. I think AthenasMommy is one of the bravest, smartest people in the world. But, taking into account her history and the 3T MRI results, I really don't get the necessity for the botox injections. I've mentioned this in other posts: I'm done with the "treatments" (torture). I've had enough. So, either someone will honor all the testing/treatments/therapies I've endured over the last 3 years, or they won't. I'm still gathering as much information as I possibly can to make the best decision about what's right for me.
Warm regards,
Karyn