Perineal Proctectomy With Bio-Thiersch Procedure for Complete Rectal Prolapse With Fecal Incontinence

Calata, Jed F.; Pai, Ajit; Marecik, Sławomir; Prasad, Leela M.; Park, John J.

doi:10.1097/dcr.0000000000000338

Cited by 4 publications

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“…Pescatori et al described improved function after Delorme's procedure with sphincteroplasty 21 and Calata et al have successfully used a biological mesh in combination with an Altemeier procedure. 15 However, both postanal repair and sphincteroplasty are more morbid and time consuming than placing a simple Thiersch suture. Furthermore, a biological mesh adds considerable expense and may increase the risk of extrusion.…”

Section: Discussionmentioning

confidence: 99%

“…12 He described placement of a subcutaneous wire circumferentially around the anus but a variety of materials (most commonly sutures) have been used to cause the same effect. [13][14][15] Historically, this technique has been associated with complications such as infection, erosion and faecal impaction. Although anal encirclement has a high recurrence rate, it has been used particularly for patients at very high risk for operative interventions, with reasonable results.…”

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confidence: 99%

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Recurrence rate after Delorme’s procedure with simultaneous placement of a Thiersch suture

Warwick

Zimmermann

Boorman

et al. 2016

annals

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Introduction Rectal prolapse is a debilitating condition usually affecting elderly women. The management is generally surgical but the optimal operation remains unclear. The recurrence rate after Delorme's procedure has been found to be similar to that for an abdominal approach. Thiersch sutures have been associated with high rates of complications and recurrence. The aim of this study was to compare the outcomes of Delorme's procedure with those of a combined Delorme-Thiersch procedure. Methods A retrospective case note review was performed of all patients who underwent Delorme's procedure for rectal prolapse between 2008 and 2014 in a single centre. Results Sixty-seven patients (63 women) underwent Delorme's procedure during the study period. The majority (85%) of patients were over 75 years old. Twelve patients had a Thiersch suture placed at the time of the procedure. The median length of stay was 3 days (range: 0-19 days). Postoperative bleeding requiring either transfusion or readmission occurred in five patients (7.5%) and two patients (3.0%) were readmitted with pain. There was no difference in the rate of complications regardless of whether a Thiersch suture had been placed. Recurrence occurred in 8.3% of those who had a Thiersch suture compared with 21.8% of those who did not (p=0.26). There was no difference in the median time to recurrence between the groups. Conclusions There was no increase in complications after placement of a Thiersch suture with Delorme's procedure. The rate of recurrence could potentially be decreased with this combined technique. Additional studies are required to investigate this further.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%