A New Modified Gant-Miwa-Thiersch Combined With Internal and External Rectal Sclerosant Injection Procedure for The Treatment of Full-Thickness Rectal Prolapse in Elderly Women

Abstract Background: Full-thickness rectal prolapse (FTRP) occurs frequently in in elderly women, and more than 100 surgical procedures have been proposed to restore FTRP. The Gant-Miwa-Thiersch (GMT) procedure is the most used treatment in China. However, the recurrence rates of GMT that reach as high as 23.8% is concerning. We described a new modified GMT combined with internal and external rectal sclerosant injection (nmGMTSI) procedure to address this problem.Methods: The nmGMTSI was performed under spinal anesthesia in 34 frail, elderly female patients with FTRP. The surgical results of FTRP were assessed. Fecal incontinence and constipation were evaluated using the Wexner score, and anal canal rest pressure (ACRP), maximum anal systolic pressure (MASP), anorectal sensation thresholds (AST), and maximum rectal tolerance (MRT) using anorectal manometry preoperatively and postoperatively. The causes of recurrence and complications were analyzed.Results: All patients were cured in accordance with clinical cure standard. The perioperative Wexner fecal incontinence score (WFIS) was 10.3±3.31, which became 3.7±2.43 (P <0.0001) postoperatively. The perioperative ACRP was 2.0±0.56 kPa, which became 8.5±2.25 kPa (P <0.0001) postoperatively. The perioperative MASP was 4.5±1.16 kPa, which became 18.6±2.50 kPa (P <0.0001) postoperatively. However, there was no significant change between preoperative and postoperative Wexner constipation scores (WCS) (17.3±2.25 vs. 15.4±2.89, P =0.1047). The AST were 38.1±5.34 mL; after the operation, it became 23.5±3.61 mL (P =0.0002).The maximum rectal tolerance (MRT) was 157.1±16.73 mL; after the operation, it became 121.2±12.45 mL (P =0.0009). The patients had no serious postoperative complications. The total relapse rate after nmGMTSI was 2.9% in the median 2 years follow-up period. The most common cause of relapse after nmGMTSI was the removal of infected threads used in the Thiersch procedure.Conclusion: The benefits of nmGMTSI include low recurrence, complications, mortality, cost and wide adaptation, minimally invasive, technically simple. It should be considered as the first option for the treatment of FTRP in frail elderly women.

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A new modified Gant-Miwa-Thiersch combined with submucosal and perirectal sclerosant injection procedure for full-thickness rectal prolapse in elderly women: clinical analysis of 34 cases

BMC Surgery ◽

10.1186/s12893-021-01284-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jinxi Wang ◽

Huiyu Li ◽

Xiaoming Ma ◽

Gang Du ◽

Jun Ma ◽

...

Keyword(s):

Fecal Incontinence ◽

Rectal Prolapse ◽

Frail Elderly ◽

Elderly Women ◽

Systolic Pressure ◽

Clinical Analysis ◽

Full Thickness ◽

Incontinence Score ◽

Minimal Invasiveness ◽

Significant Difference

Abstract Background Full-thickness rectal prolapse (FTRP) frequently occurs in elderly women, and more than 100 surgical procedures have been proposed to restore FTRP. The Gant-Miwa-Thiersch (GMT) procedure is the most used treatment in China. However, the recurrence rate of FTRP post-GMT, which is as high as 23.8%, is concerning. We described a new modified GMT combined with internal and external rectal sclerosant injection (nmGMTSI) procedure to address this problem. Methods The nmGMTSI was performed under spinal anesthesia in 34 frail, elderly female patients with FTRP. The surgical results of FTRP were assessed. Fecal incontinence and constipation were evaluated using the Wexner score, and anal canal rest pressure (ACRP), maximum anal systolic pressure (MASP), anorectal sensation thresholds (AST), and maximum rectal tolerance (MRT) using anorectal manometry preoperatively and postoperatively. The causes of recurrence and complications were analyzed. Results All patients were cured according to the clinical cure standard. The perioperative Wexner fecal incontinence score (WFIS) was 10.3 ± 3.31, which became 3.7 ± 2.43 (P < 0.0001) postoperatively. The perioperative ACRP was 2.0 ± 0.56 kPa, which became 8.5 ± 2.25 kPa (P < 0.0001) postoperatively. The perioperative MASP was 4.5 ± 1.16 kPa, which became 18.6 ± 2.50 kPa (P < 0.0001) postoperatively. However, no significant difference was observed between the preoperative and postoperative Wexner constipation scores (WCS) (17.3 ± 2.25 vs. 15.4 ± 2.89, P = 0.1047). The perioperative and postoperative AST were 38.1 ± 5.34 mL and 23.5 ± 3.61 mL, respectively (P = 0.0002). The maximum rectal tolerance (MRT) was 157.1 ± 16.73 mL, which became 121.2 ± 12.45 mL postoperatively (P = 0.0009). The patients developed no serious postoperative complications. The total relapse rate after nmGMTSI was 2.9% in the median two years follow-up period. The most common cause of relapse after nmGMTSI was the removal of infected threads used in the Thiersch procedure. Conclusion The benefits of nmGMTSI include low rates of recurrence, complications, and mortality, cost-effectiveness, wide adaptation, minimal invasiveness, and technical simplicity. Hence, it should be considered the first option for the treatment of FTRP in frail elderly women.

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Rectal Prolapse: Perineal Procedures

10.2310/surg.2406 ◽

2019 ◽

Author(s):

Steven D. Wexner ◽

Susan M. Cera ◽

Victoria Valinluck Lao

Keyword(s):

Fecal Incontinence ◽

Rectal Prolapse ◽

Key Words ◽

Rectal Wall ◽

Preoperative Evaluation ◽

Full Thickness ◽

Recent Advances

Rectal prolapse is a condition wherein a full thickness intussusception of the rectal wall protrudes out of the anus. The diagnosis is rare, ~ 0.5% of the population, and occurs most often in elderly females. The diagnosis is associated with constipation, fecal incontinence, or both. The repair of rectal prolapse can be divided into perineal and abdominal procedures. In this review, we will discuss preoperative evaluation, management and planning as well as describe key widely accepted perineal procedures, the Delorme and Altemeier, and report recent advances. Abdominal procedure and advances in that arena will be discussed in a separate review. This review contains 9 figures, 7 tables, and 32 references. Key words: Rectal prolapse, perineal procedure, resection, Altemeier, Delorme, Thiersch wire, perineal stapled resection, levatoroplasty

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Perineal stapled prolapse resection (PSPR) for full thickness external large rectal prolapse in a frail elderly patient; An easy to teach and reproducible novel technique – a video vignette

Colorectal Disease ◽

10.1111/codi.15883 ◽

2021 ◽

Author(s):

Akinfemi A. Akingboye ◽

Sarah Khalid ◽

Riccardo Broggi ◽

Antonella Scorza ◽

Sofia Todero ◽

...

Keyword(s):

Elderly Patient ◽

Rectal Prolapse ◽

Frail Elderly ◽

Full Thickness ◽

Frail Elderly Patient ◽

Novel Technique ◽

Perineal Stapled Prolapse Resection ◽

Video Vignette

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Rectal Prolapse: Abdominal Procedures

10.2310/surg.2407 ◽

2019 ◽

Author(s):

Steven D. Wexner ◽

Susan M. Cera ◽

Victoria Valinluck Lao

Keyword(s):

Fecal Incontinence ◽

Rectal Prolapse ◽

Key Words ◽

Sigmoid Colon ◽

Rectal Wall ◽

Full Thickness ◽

Resection Rectopexy ◽

Benign Condition ◽

Operative Evaluation

Rectal prolapse is the full thickness intussusception of the rectal wall with protrusion out of the anus. It is a benign condition associated with multiple anatomic abnormalities such as a redundant sigmoid colon, attenuation of sacral attachments, diastasis of the levators, a patulous anus, and a deep cul-de-sac. It often presents with concomitant symptoms of fecal incontinence and constipation, or both. In this review, we will discuss widely accepted abdominal procedures for the repair of rectal prolapse as well as advances in the arena. Pre-operative evaluation, management and planning as well as perineal procedures are discussed in a separate review. This review contains 9 figures, 1 table, and 44 references. Key Words: Rectal prolapse, abdominal procedures, resection, rectopexy, mesh, laparoscopic, robotic

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Long-term impact of full-thickness rectal prolapse treatment on fecal incontinence

Surgery ◽

10.1016/j.surg.2015.03.005 ◽

2015 ◽

Vol 158 (1) ◽

pp. 104-111 ◽

Cited By ~ 11

Author(s):

Timothée Wallenhorst ◽

Guillaume Bouguen ◽

Charlène Brochard ◽

Diane Cunin ◽

Véronique Desfourneaux ◽

...

Keyword(s):

Fecal Incontinence ◽

Rectal Prolapse ◽

Full Thickness ◽

Long Term Impact

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Faculty Opinions recommendation of No rectopexy versus rectopexy following rectal mobilization for full-thickness rectal prolapse: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.7935956.8451056 ◽

2011 ◽

Author(s):

Vassiliki Tsikitis

Keyword(s):

Randomized Controlled Trial ◽

Rectal Prolapse ◽

Controlled Trial ◽

Full Thickness ◽

Randomized Controlled ◽

Rectal Mobilization

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Therapeutic Effect of Changqiang Acupoint Injection on Children with Functional Fecal Incontinence

Acupuncture & Electro-Therapeutics Research ◽

10.3727/036012921x16298112109466 ◽

2021 ◽

Author(s):

Changying Yi ◽

Jie Zhang ◽

Meili Fan

Keyword(s):

Treatment Group ◽

Fecal Incontinence ◽

Cleveland Clinic ◽

Control Group ◽

Incontinence Score ◽

Randomized Controlled Clinical Trials ◽

Randomized Controlled ◽

Stool Incontinence ◽

Acupoint Injection ◽

Significant Difference

Objective: Functional fecal incontinence in children (FFIC), also known as functional fecal disorder in children, is a type of childhood diseases characterized by excretory dysfunction. In the study, we observed the clinical effect of Changqiang acupoint injection on functional fecal incontinence in children (FFIC) by randomized controlled clinical trials. Materials and methods: 140 children with functional fecal incontinence who met the screening criteria were respectively assigned into the treatment group (100 cases) and the control group (40 cases) according to the completely randomized controlled design. In the treatment group, Chuankezhi injection was administrated at the Changqiang acupoint once a week for three weeks (one course of treatment). In contrast, the subjects in the control group was instructed to receive sphincter exercise and defecation training, followed by an assessment on the therapeutic efficacy after one course of treatment. Results: The overall response rate of the two groups was 93.00% (93/100) and 57.50% (23/40), respectively, with a statistically significant difference (P<0.01). The treatment group showed a performance superior to the control group based on the Cleveland Clinic Florida Fecal Incontinence Score System (CCF-FI)—dry stool incontinence, liquid incontinence, gas incontinence, lifestyle change, necessity of using pads or antidiarrheals, the ability to delay defecation, and the total score. The inter-group comparison revealed a statistically significant difference (P<0.01). Conclusion:Changqiang acupoint injection has significant curative effect on FFIC as demonstrated by significant relief in the symptoms associated with fecal incontinence, and thus is considered as a useful approach to be widely applied in clinical practice.

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