Successful treatment of recurrent rectal prolapse using three Thiersch sutures in children

Abstract

Many techniques are described to manage recurrent rectal prolapse in children, including repeated Thiersch stitch, phenol injections, Delorme and Altemeier procedures, and rectopexy. We describe a case of successful treatment of rectal prolapse by placing three Thiersch sutures circumferentially along the anal canal--a simple and novel modification of a well-known procedure. An 8-year-old boy with full-thickness rectal prolapse was treated with laxatives to no avail. He was subsequently treated with phenol-in-almond-oil injection and insertion of a 1/0PDS Thiersch suture. The effects were temporary with recurrence 3 months later. A further phenol-in-almond-oil injection was given and a 1/0PDS Thiersch suture placed, and the patient was discharged on laxatives. Recurrence occurred again at 3 months. This was treated with three circumferential Thiersch sutures along the anal canal--one Prolene 2/0 and two 1/0PDS. There has been no recurrence at follow-up. Placement of three sequential Thiersch sutures along the rectum is effective in treating recurrent rectal prolapse and a good alternative to major rectopexy.

Two Rings, Two Recoveries: Exploring the Thiersch Method in Complicated Cases

“…If sclerotherapy fails, then the Thiersch procedure is recommended. The two procedures combined have a higher success rate than when performed separately, as demonstrated in the case report published by Chauhan et al [ 11 ]. Here, three Thiersch sutures using PDS and proline were done in children suffering from possible Rasmussen's syndrome with recurrent complaints of rectal prolapse [ 11 ].…”

“…The two procedures combined have a higher success rate than when performed separately, as demonstrated in the case report published by Chauhan et al [11]. Here, three Thiersch sutures using PDS and proline were done in children suffering from possible Rasmussen's syndrome with recurrent complaints of rectal prolapse [11]. Other approaches have been advocated as alternatives or improvements to the Thiersch operation.…”

The combination of sclerotherapy and anal cerclage: treatment of choice for rectal prolapse in children?

“…2 It is a common condition in children. 3 Diagnosis is clinical and straightforward, relying mainly on history-taking and physical examination. Treatment is based primarily on hygienic-dietary measures and medical therapy.…”

Sclerotherapy for the management of rectal prolapse in children

“…If prolapse persists despite optimal management, various strategies exist for treatment. These include injection sclerotherapy [4][5][6][7][8][9][10][11][12][13][14][15][16][17], encircling of the anus, also known as the Thiersch operation [10,18], abdominal operations [3,13,19,20], and perineal operations [10,21]. Given the varied approaches, no one technique currently predominates thereby creating a wide heterogeneity in practice patterns.…”