recent surgery
Posted: Mon Dec 24, 2018 4:00 am
Hi Everyone,
I had my left pudendal nerve decompression surgery with Dr. Hibner on Dec. 18, and it went well. Dr. Hibner and his fellow were “very excited” about the outcome. They said they found the nerve quickly and that it was “quite flattened” in the area between the two ligaments (sacrotuberous and sacrospinous) and that it became round after he removed the scar tissue from the nerve. They said it looked like it was compressed and that it was densely attached to the SS ligament. And he said that they were able to access a very large part of the nerve. He said that it helped them that I am tall and thin. I, of course, wanted to know if all of this meant I had a good chance of improving, and he said that he hasn’t been able to see any clear relationship between what he finds in surgery and how much people improve. But, he also said that he thought I would do really well. So I’m overjoyed that it went well, relieved that it appeared to be compressed, and hopeful that it will improve.
Two other notes—one for those who can sit without an increase in pain and one for those considering surgery:
(1) It was difficult to make the decision to do the surgery, in part because I could sit without an increase in pain, something very unusual for a pn patient. Hibner explained to me in September and again in my pre-surgery appointment in December that he has been finding that in a sub-group of patients—those wherein the SSL and the STL are very close together—that sitting actually relieves pain because it separates those ligaments a little bit. So, that helped me feel like surgery was the way to go, but it was still a relief to hear from him in the post-op report that it looked like it was, indeed, compressed between those ligaments. So, given what he is learning and my own case, I don’t think it makes sense to consider an increase in pain when sitting as an essential criterion of pne. If you have the other pne symptoms (which I did) but not this one, you could still have a compressed pudendal nerve.
(2) I am very glad that I did the surgery with Hibner. He seems to be refining the surgery in ways that improve the odds of success: (1) cutting (rather than splitting) the ST ligament for greater visualization, (2) using a z-cut on the ST ligament to elongate it and strengthen the stitching, (3) detaching the SS ligament from the ischial spine to create more space for the nerve (the SSL is so small that it just retracts to the sacrum after being detached), (4) wrapping the nerve in an amniotic membrane to promote healing, (5) putting a wound vac on the incision to promote healing and reduce the odds of infection, and (6) implanting a bupivacaine pump to numb the pudendal nerve and buttock for 5-10 days after surgery. It’s not clear to me (from a bit of comparison shopping) that the other surgeons are using these techniques (at least not all of them), and I think they all make a lot of sense.
April
I had my left pudendal nerve decompression surgery with Dr. Hibner on Dec. 18, and it went well. Dr. Hibner and his fellow were “very excited” about the outcome. They said they found the nerve quickly and that it was “quite flattened” in the area between the two ligaments (sacrotuberous and sacrospinous) and that it became round after he removed the scar tissue from the nerve. They said it looked like it was compressed and that it was densely attached to the SS ligament. And he said that they were able to access a very large part of the nerve. He said that it helped them that I am tall and thin. I, of course, wanted to know if all of this meant I had a good chance of improving, and he said that he hasn’t been able to see any clear relationship between what he finds in surgery and how much people improve. But, he also said that he thought I would do really well. So I’m overjoyed that it went well, relieved that it appeared to be compressed, and hopeful that it will improve.
Two other notes—one for those who can sit without an increase in pain and one for those considering surgery:
(1) It was difficult to make the decision to do the surgery, in part because I could sit without an increase in pain, something very unusual for a pn patient. Hibner explained to me in September and again in my pre-surgery appointment in December that he has been finding that in a sub-group of patients—those wherein the SSL and the STL are very close together—that sitting actually relieves pain because it separates those ligaments a little bit. So, that helped me feel like surgery was the way to go, but it was still a relief to hear from him in the post-op report that it looked like it was, indeed, compressed between those ligaments. So, given what he is learning and my own case, I don’t think it makes sense to consider an increase in pain when sitting as an essential criterion of pne. If you have the other pne symptoms (which I did) but not this one, you could still have a compressed pudendal nerve.
(2) I am very glad that I did the surgery with Hibner. He seems to be refining the surgery in ways that improve the odds of success: (1) cutting (rather than splitting) the ST ligament for greater visualization, (2) using a z-cut on the ST ligament to elongate it and strengthen the stitching, (3) detaching the SS ligament from the ischial spine to create more space for the nerve (the SSL is so small that it just retracts to the sacrum after being detached), (4) wrapping the nerve in an amniotic membrane to promote healing, (5) putting a wound vac on the incision to promote healing and reduce the odds of infection, and (6) implanting a bupivacaine pump to numb the pudendal nerve and buttock for 5-10 days after surgery. It’s not clear to me (from a bit of comparison shopping) that the other surgeons are using these techniques (at least not all of them), and I think they all make a lot of sense.
April