The pudendal nerve and its branches in relation to the Richter’s procedure
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Date
Authors
Van der Walt, Sone
Oettle, Anna Catherina
Van Wijk, Frans Jacob
Journal Title
Journal ISSN
Volume Title
Publisher
Karger
Abstract
OBJECTIVE : Variations in the branching pattern of the pudendal nerve (PN) have been described in the literature. This study investigated these variations in order to comment on a safe area for the placement of a Richter's stitch. METHODS : Richter's procedure was performed on nine unembalmed female cadavers and followed by dissection. PN dissections were done on another 20 embalmed female cadavers. Variations in the branching pattern of the PN were noted and the distance between the Richter's stitch placed and the PN/or the inferior rectal nerve (IRN) measured. RESULTS : The IRN entered the gluteal region as a separate structure in 6/29 cases. The separate IRN was found to pass between 4.1 and 14.45 mm medial to the ischial spine in 18/29 cases. In one case, the Richter's stitch was found to pierce the IRN. The distance between the stitch and the PN and/or the IRN ranged from 0 to 17.8 mm. CONCLUSIONS : To minimize the risk of nerve damage or entrapment, the Richter's stitch should be placed >20 mm from the ischial spine. This recommended area should be revised for different population groups, as variations might exist between groups.
Description
Keywords
Richter’s procedure, Sacrospinous ligament, Vaginal prolapse, Safe area, Pudendal nerve (PN), Inferior rectal nerve (IRN)
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Citation
Van Der Walt, S, Oettlé, AC & Van Wijk, FJ 2016, 'The pudendal nerve and its branches in relation to the Richter’s procedure', Gynecologic and Obstetric Investigation, vol. 81, no. 3, pp. 275-279.