Use of polyethylene in the Thiersch operation

Radiofrequency coagulation with Thiersch's operation--a better palliative treatment in prolapse rectum

PURPOSE

Thiersch operation is an age-old popular option for treatment of complete rectal prolapse (proctodentia) in elderly patients. This procedure is simple, easy to perform, and with very rare postoperative complications of any severe nature. This is especially suitable for those patients who are unfit for extensive abdominal surgical procedures in practice today. This procedure does help in mechanically supporting and containing the prolapse. Although the procedure is not curative, the confining of the prolapse in the anal canal does ensure a relief from symptoms generated by the prolapse. Nevertheless, withdrawal of the occlusive material used is inevitably followed by recurrence of the prolapse, making the procedure a failure in achieving a prolonged relief.

METHODS

Looking at this drawback, we have made an addition to this conventional procedure by introducing circumferential coagulation of the subanodermal region through a radio frequency device. This results in inducing fibrosis and forming a zone of band. The added maneuver constricts the anal opening permanently and thus aids in reinforcement of the atonic sphincter. The study was carried out in 8 patients. Their average age was 57 years. All of them had complete prolapse of the rectum with associated features. Two of them were in early fifties, but they refused to undergo extensive procedures and opted for this method considered cheaper and quicker.

RESULTS

A follow-up for a period ranging from 15 to 18 months was found satisfactory. None of the patients had any prolapse or its sequel. Not a single case was reported for any sinus or discharge from the site of incision. The incision site was well consolidated, and the knot or the thread could not be felt when seen after 12 months.

CONCLUSIONS

The study shows that radio frequency coagulation followed by Theirsch operation for complete rectal prolapse in the elderly has been found to be relatively easy to perform. Except for the radio surgical unit, no special instrumentation is needed. The results of this procedure have been found to be gratifying in all the patients. It is felt that on appropriate selection of the patients and employing this new technique of operation would prove a boon in treatment of this problem. A further work in this direction and longer follow-up of the treated patients are bound to bring about exciting new dimensions in the field.

Treatment of rectal prolapse by sphincteric support using silastic rods

The use of silastic perianal rings to control rectal prolapse in the elderly has been reviewed. Forty-one patients were treated over a 6 year period by a total of 52 operations. Their mean age was 80 years and there was no operative mortality. Prolapse was adequately controlled in 71 per cent of patients, and a further three patients had no recurrence despite failure and removal of the ring. The results of this procedure are inferior to those obtained by abdominal operations for rectal prolapse, but deserve serious consideration in those elderly patients who may be unfit for laparotomy.

An artificial sphincter: a preliminary report

A new method of providing continence to patients with fecal stomas is presented. The device, used as an artificial sphincter, consists of an inflatable Silastic balloon, which is implanted in the subcutaneous tissue around the stoma; it is easily handled by the patient. The artificial sphincter was used in six patients with colostomies. In all cases, satisfactory continence of the stoma was achieved, obviating the need to use enemas, bags or other appliances. In three patients subcutaneous infections developed around the prosthesis. In two cases, this was readily controlled; in one case, the prosthesis had to be removed. The other five patients are well and continent. None of the patients experienced pain or discomfort during use of the prosthesis. There has been no stomal ischemia.