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Inside the Operating Room with Dr Tollestrup The Details on Piriformis Muscle Removal Surgery

One of the big parts of this operation is just getting down to the piriformis muscle, because it’s basically right in the center of the pelvis, this structure. The size of the patient can really make this an easy or a harder endeavor. And what I use the fluoroscopy for is there are certain bony landmarks that will allow you to come straight down on the piriformis muscle every time. And that’s sort of a key part of the operation. If you’re off target even a centimeter or two, it can really make the operation a lot more difficult.

Go through the layer of the skin and the adipose tissue, then you have to go through the buttock muscle, and luckily the way everything lines up, it’s all kind of in the same direction. So you can just do what’s called a muscle splitting technique. That way you’re not having actually to cut the muscle fibers of the gluteus maximus muscle. And so it’s a lot less pain for the patient and less morbid. And once you take the retractor out, it just all falls right back together.

And then what you see is just this amorphous layer of adipose tissue. It’s just all the yellow. So you have to open up this deep pelvic compartment, fascia. This is one of the things about this operation, when you first start doing it it’s a little bit intimidating because it’s impossible to see anything. And there are big blood vessels down here and other nerves and you have to get through this fat without injuring any of that. And just kind of feeling the structures helps a lot to kind of keep you sort of knowing where things are and what direction you need to be going and stuff. Using the retractor is a critical part of the operation. I mean, it’s hard to do this operation without good retraction that would keep everything steady. But at the same time, you have to be very careful about how you use it. And the pressure that the blades are exerting, because there’s all these important structures running underneath this tissue, other important nerves.

The recovery from the surgery is for most people, a couple of weeks, I would say. For most people at a couple of weeks, their surgical pain is pretty much gone. It can vary widely though. Some people just really don’t have that much pain. And I would say that most people don’t have a lot of pain in the post-op recovery period, but there’s soreness in this area from the surgery.

This operation can take as little as an hour and 15 minutes or as long as five hours, all depending on factors like scar tissue and whatnot. How that translates given an individual’s own physiology and how prone they are to making scar tissue and how dense that scar tissue is that can vary a lot from patient to patient. And so you don’t know for sure exactly what you’re getting into. Sometimes the scar tissue is a lot better than you anticipated, and sometimes it’s a lot worse, and just kind of have to roll with it.


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