Coccygectomy
Coccygectomy is a surgical procedure during which the coccyx is removed. It can be performed for many reasons for instance in patients with coccyx pain (tailbone pain), however it is typically reserved for patients with malignant cancer or for patients whose tailbone pain has failed to respond to nonsurgical treatment (such as medications by mouth, use of seat cushions, and medications given by local injections done under fluoroscopic guidance).[1]
In humans, coccygectomy is the treatment of last resort for coccydynia, but is considered a required treatment for sacrococcygeal teratoma and other germ cell tumors arising from the coccyx.
To preserve normal defecation, coccygectomy normally is accompanied by re-attachment (also known as re-approximation) of the two levator ani muscles and of the perineum, parts of the pelvic floor. In adults who undergo coccygectomy, one infrequent complication is a subsequent perineal hernia or coccygeal hernia. In these hernias, bowel or other pelvic contents bulge downward and out of the pelvis through a weakened pelvic floor. This complication has not been reported in persons who underwent coccygectomy while a baby or child. A milder version of hernia is when someone just has prolapse (sagging) of the pelvic floor. To repair these hernias, a variety of surgical techniques have been described.[2][3][4]
Complications and risks
First there are the risks that are associated with the general anaesthesia itself. An additional possible complication of coccygectomy includes infection at the surgical site. The fairly common occurrence of these post-operative infections is apparently due to the site's proximity to the colon and anus, thus leading to bacterial contamination of the surgical site by bacteria from the patient's stool (bowel movements). This may result in the need for repeat surgery at that site to treat the infection, in approximately 20% of coccygectomy patients. Another complication is prolonged pain at the surgical site, or failure to relieve the pain that the patient was having prior to surgery.
Success rates
The coccygectomy operation had a very bad reputation in the past, and many doctors still advise that the surgery should be avoided at all costs. However current data from clinical trials reports success rates of 50 up to 90%, a percentage that rises to 80-90% in patients that are considered to be 'good candidates' for this kind of surgery. A study that was published in 2001 covering a total of 702 patients had good or excellent results in 83% of cases.[5]
See also
References
- ^ Foye PM (2007). "Reasons to delay or avoid coccygectomy for coccyx pain". Injury. 38 (11): 1328. doi:10.1016/j.injury.2007.06.022. PMID 17884057.
- ^ Zook NL, Zook EG (July 1997). "Repair of a long-standing coccygeal hernia and open wound". Plast. Reconstr. Surg. 100 (1): 96–9. doi:10.1097/00006534-199707000-00017. PMID 9207665.
- ^ Berrevoet F, Pattyn P (June 2005). "Use of bone anchors in perineal hernia repair: a practical note". Langenbecks Arch Surg. 390 (3): 255–8. doi:10.1007/s00423-004-0523-6. PMID 15580523.
- ^ Miranda EP, Anderson AL, Dosanjh AS, Lee CK (September 2007). "Successful management of recurrent coccygeal hernia with the de-epithelialised rectus abdominis musculocutaneous flap". J Plast Reconstr Aesthet Surg. 62 (1): 98–101. doi:10.1016/j.bjps.2007.08.002. PMID 17889632.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Coccygektomi kan være en behandlingsmulighed ved kronisk coccygodyni (Coccygectomy may be a treatment option for chronic coccydynia) Ugeskr Læger 2011 Feb 14; 173(7): 495-500. In Danish. Aarby, Nanett Skjellerup (1), Trollegaard, Anton Mitchell (2) and Hellberg, Steen (2) http://www.coccyx.org/medabs/aarby.htm