Endoanal/endovaginal ultrasound-assisted bilateral partial miotomy of the puborectalis for anismus

Anismus, or non-relaxing puborectalis muscle (PRM), affects 44 % of the patients suffering from obstructed defecation [1]. Biofeedback is considered the first therapeutic option in our unit, but it takes time and the patient needs to be compliant [2, 3]. Partial bilateral myotomy of the PRM is a safe and effective procedure for obstructed defecation due to anismus in selected patients [4]. Our modified minimally invasive approach with two small perianal incisions consists in “blindly” hooking the PRM prior to the myotomy [5]. Concern may arise whether the correct muscle is hooked and divided. We investigated whether intraoperative ultrasound may help to better identify the PRM, thus avoiding accidental division of the adjacent deep part of the external anal sphincter.