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.