Dr. Ansell's TG Approach

[Karyn]

Hi,
I came across this article from Dr. Ansells website regarding his surgical approach for the ST & SS ligaments:

http://foundationhouston.com/services/p ... ease.shtml

An incision is made in the buttock on either or both sides. It extends through the gluteal muscles. A section of the ST ligament is removed and the SS ligament is divided releasing any compression at the ischial spine. The pudendal canal is explored and an incision is made to release the nerve from any binding fascia.

I was under the impression he completely severed the STL, but after reading article, I'm getting a different interpretation. Any comments?

Kind regards,
Karyn

[ezer]

If I remember this is the topic that created such a stir several years ago. I think that Dr.Robert called it "windowing" of the ST ligament. Many people thought it was a small rectangular incision (while preserving the ligament) when in fact the ligament was simply sectioned at both ends thus the windowing.

[Karyn]

Thanks, Ezer. I can't vouch for the validity of this, but found the following on TIPNA:
http://www.tipna.org/forum/viewtopic.php?t=993

Many people thought it was a small rectangular incision (while preserving the ligament) when in fact the ligament was simply sectioned at both ends thus the windowing.

Apparently, "windowing" means different things to different people. A surgeon described it to me as making a medial, lateral incision in the ligament. This is much different.

[ezer]

Karyn, yes that picture is correct. Maybe it was lost in translation from French, who knows. But many patients were outraged as they believed that the ST had been preserved which was not the case at all.

[Karyn]

But many patients were outraged as they believed that the ST had been preserved which was not the case at all.

Can't say I blame them, Ezer. How very misleading!!! I mean, we all know what a "window" is. Maybe it's just me, but when I think of window, I'm thinking of an opening inside of a structure. Doesn't matter if it's a square, rectangle, oval, circle ... there's still structure surrounding a window!
I find Dr. Ansell's description of how he addresses the ligaments confusing. He uses different terminology for each of them.
SSL - is divided. My interpretation of "divided", is that it's cut and separated in it's entirety.
STL = A section of the ligament is removed. To me, this sounds different than dividing. Almost sounds very similar to an IT Band Release, where a piece of the ligament is notched.
Thanks very much for your input, Ezer. This has been helpful!
Best,
Karyn

[ezer]

Karyn
Yes, it is a very large window indeed! The entire ligament is removed.
But Dr.Ansell does exactly the same, the "section" being the ligament cut at both ends thus removed.

[Karyn]

Yes, it is a very large window indeed! The entire ligament is removed.

Arrgghhh! Well, how the hell is THAT a window?!?!? Sounds more like a DOOR to me! But wait! Even then ... a doorway is surrounded by a structure.
I dunno ....