Bio-Thiersch as an Adjunct to Perineal Proctectomy Reduces Rates of Recurrent Rectal Prolapse
| Autor: | Jed F. Calata, Jeremy Sugrue, Johan Nordenstam, Saleh M. Eftaiha, Anders Mellgren, Slawomir J. Marecik, Leela M. Prasad, John J. Park |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Rectum Anal Canal Perineum Teaching hospital 03 medical and health sciences 0302 clinical medicine Recurrence medicine Humans In patient Digestive System Surgical Procedures Aged Retrospective Studies Aged 80 and over Bioprosthesis business.industry Gastroenterology Outcome measures General Medicine Rectal Prolapse Middle Aged Surgical Mesh Anus medicine.disease Colorectal surgery Surgery Rectal prolapse medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Case-Control Studies 030211 gastroenterology & hepatology Female business Thiersch procedure |
| Zdroj: | Diseases of the colon and rectum. 60(2) |
| ISSN: | 1530-0358 |
| Popis: | BACKGROUND The rates of recurrent prolapse after perineal proctectomy vary widely in the literature, with incidences ranging between 0% and 50%. The Thiersch procedure, first described in 1891 for the treatment of rectal prolapse, involves encircling the anus with a foreign material with the goal of confining the prolapsing rectum above the anus. The Bio-Thiersch procedure uses biological mesh for anal encirclement and can be used as an adjunct to perineal proctectomy for rectal prolapse to reduce recurrence. OBJECTIVE The aim of this study was to evaluate the Bio-Thiersch procedure as an adjunct to perineal proctectomy and its impact on recurrence compared with perineal proctectomy alone. DESIGN A retrospective review of consecutive patients undergoing perineal proctectomy with and without Bio-Thiersch was performed. SETTINGS Procedures took place in the Division of Colon and Rectal Surgery at a tertiary academic teaching hospital. PATIENTS Patients who had undergone perineal proctectomy and those who received perineal proctectomy with Bio-Thiersch were evaluated and compared. INTERVENTIONS All of the patients with rectal prolapse received perineal proctectomy with levatorplasty, and a proportion of those patients had a Bio-Thiersch placed as an adjunct. MAIN OUTCOME MEASURES The incidence of recurrent rectal prolapse after perineal proctectomy alone or perineal proctectomy with Bio-Thiersch was documented. RESULTS Sixty-two patients underwent perineal proctectomy (8 had a previous prolapse procedure), and 25 patients underwent perineal proctectomy with Bio-Thiersch (12 had a previous prolapse procedure). Patients who received perineal proctectomy with Bio-Thiersch had a lower rate of recurrent rectal prolapse (p < 0.05) despite a higher proportion of them having had a previous prolapse procedure (p < 0.01). Perineal proctectomy with Bio-Thiersch had a lower recurrence over time versus perineal proctectomy alone (p < 0.05). LIMITATIONS This study was limited by nature of being a retrospective review. CONCLUSIONS Bio-Thiersch as an adjunct to perineal proctectomy may reduce the risk for recurrent rectal prolapse and can be particularly effective in patients with a history of previous failed prolapse procedures. |
| Databáze: | OpenAIRE |
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