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Coccygectomy

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Title: Coccygectomy  
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Subject: Arthrotomy, Ostectomy, Astragalectomy, Sacrococcygeal teratoma, Surgical oncology
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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 remove the coccyx, an incision is made from the tip of the coccyx to its joint with the sacrum. The coccyx is cut away from the surrounding tissues, cut off at the joint with the sacrum, and removed. If the tip of the sacrum is rough, it is filed down. The wound is closed in layers.[2][3]

Complications and risks

First there are the risks that are associated with the general anaesthesia itself.

An additional possible complication of coccygectomy is infection at the surgical site, apparently due to the site's proximity to the colon and anus, leading to 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. However, the use of prophylactic antibiotics, preoperative rectal enema, closure of the wound in two layers and use of a topical skin adhesive have been shown to reduce the rate of infection to 0%.[3]

In adults who undergo coccygectomy, one rare 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.[4][5][6]

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.[7]

See also

References

  1. ^ Foye PM (2007). "Reasons to delay or avoid coccygectomy for coccyx pain". Injury 38 (11): 1328.  
  2. ^ An improved technic of coccygectomy. Clinical Orthopedics, 85: 143-145, 1972. Richard C Gardner. http://www.coccyx.org/medabs/gardner.htm
  3. ^ a b Prevention of post-coccygectomy infection in a series of 136 coccygectomies. International Orthopaedics, 2011, 35 (6): 877-81. Doursounian L, Maigne JY, Cherrier B, Pacanowski J. http://www.coccyx.org/medabs/doursou3.htm
  4. ^ Zook NL, Zook EG (July 1997). "Repair of a long-standing coccygeal hernia and open wound". Plast. Reconstr. Surg. 100 (1): 96–9.  
  5. ^ Berrevoet F, Pattyn P (June 2005). "Use of bone anchors in perineal hernia repair: a practical note". Langenbecks Arch Surg 390 (3): 255–8.  
  6. ^ 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.  
  7. ^ 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

External links

  • Coccygectomy Information
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