Assumesh for TPS (Transverce Perineal Support)

Assumesh non-absorbable mesh pre-shaped for TPS procedure (Transverce Perineal Support)

BACKGROUND
Obstructed defecation syndrome (ODS) is a significant clinical problem. The etiopathogenesis of ODS can be recognized both in functional disorders, secondary to a spastic syndrome of the pelvic floor, and in an anatomical alteration of the rectum, such as rectocele and rectal intussusception, subject to surgical correction. Perineal Descending (PD) is also associated with ODS and one of the main causes is believed to be excessive and repetitive strain which can lead to weakness of the pelvic floor muscles. In turn, this can cause more tension, establishing a vicious cycle.
Although Descending Perineum can be observed in 75-84% of patients with ODS, and despite the widely accepted association between chronic constipation and excessive descent of the perineum, currently proposed surgical procedures are almost exclusively directed at correcting rectal intussusception and/or or the rectocele.

TPS RATIONALE
The rationale for the TPS procedure is to mimic the role of the superficial transversus perineal muscle. In normal subjects, an important role in limiting excessive perineal descent appears to be played by the functional activity of the transverse, superficial and deep perineal muscles. Their contraction during defecation presumably supports the perineal floor and protects the perineum from the high pressure produced by the effort which, if excessive and repetitive, can cause weakness, subluxation and failure of the perineal muscles, resulting in perineocele, enterocele or sigmoidocele. In patients with pathological descending perineum, the Valsalva maneuver, due to the excessive laxity of the perineum, can only determine a change in the shape of the abdominal cavity (with a greater depth of the pelvis, up to the formation of a perineocele) without obtaining a reduction of the abdominal volume. Therefore, the expected increase in intra-abdominal and intra-rectal pressure, necessary to push the feces outward through the anal sphincters, cannot be achieved.

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SKU: TPS MESH_ITA Categories: , ,


TPS AND CURRENT COLORECTAL SURGICAL PROCEDURES

Currently, surgical procedures for the treatment of (ODS) can be divided into two broad categories: rectal resection procedures, performed mainly with a transanal approach, and rectal suspension procedures, performed mainly laparoscopically; the latter usually involve the use of biological or synthetic implants. Both categories of procedures, rectal resection and rectal suspension, aim to treat occult rectal prolapse and rectocele, which are considered the main etiopathogenetic factors of ODS.
Without going into detail about the advantages and disadvantages of these two approaches, it is interesting to note that neither of these procedures takes into account either the pathophysiological role that pathological perineal descent can play in ODS or the high frequency with which it occurs.
In fact, a pathological perineal descent is present in more than 75% of patients with ODS and can be seen in 84% of patients who have had failure after any surgical procedure, rectal resection or suspension, performed to treat ODS.

TPS AND PELVIC FLOOR PROCEDURES USED IN GYNECOLOGY
In the last ten years, meshes have been increasingly used in the surgical management of stress urinary incontinence (mid-urethral slings) and pelvic organ prolapse (sacrocolpopexy and transvaginal repairs) in an attempt to improve success rates and increase the longevity of repairs. However, TPS differs from the techniques mentioned above not only in the clinical indication but also in the anatomical location of the mesh (just above the superficial fascia of the perineum). In this position, while creating a supporting element for the pelvic floor, the implant is not in direct contact with the pelvic organs and in no case generates traction/suspension on the latter.

CONCLUSION

TPS is a safe and effective procedure in the treatment of obstructed defecation syndrome associated with the descending perineum. The procedure is simple to perform, easy to learn and with a short post-operative hospital stay.

KIT CODE CODES DESCRIPTION / SIZES UNITS
TPS AM0311 Polypropylene mesh, pre-shaped, Vertical Cut, 3 cm x 12 cm 1
 PS028HHAC Filbloc Permanent for ENDO 360° – 22 mm – Non-absorbable unidirectional barbed polypropylene suture with final lock, USP 2/0, length 20 cm  

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