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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1782
Gupta P. J.
Consulting Proctologist Gupta Nursing Home, Nagpur, India
Aim. Breakage, poor tolerance, non-extensibility of the occlusive material and infection in the wire tract are some of the reasons for disfavor towards use of Thiersch’s procedure in complete rectal prolapse. However, this procedure still has a place for the treatment of complete rectal prolapse in the elderly and high-risk patients. The author describes a modification of this procedure by inducing fibrosis at the anal verge through circumferential subanodermal coagulation using a radiofrequency device.
Methods. This retrospective study describes the procedure and postoperative events in 38 elderly patients who otherwise, were considered as poor risk patients for any curative procedure for rectal prolapse. A Ellman radiofrequency generator was used for coagulation. The patients were followed over a period of 2 years and a satisfaction score with the procedure was assessed.
Results. Postoperative complications were observed in two patients. One of these developed suppuration in the tract of the encircling wire that needed removal, while the other had a recurrence due to loosening of wire. At 2-year follow-up, three patients developed recurrence while one had a persistent complaint of incontinence. The remaining patients expressed their satisfaction with the treatment due to relief from prolapse and associated symptoms.
Conclusion. This study shows that a combined procedure of radiofrequency coagulation followed by Thiersch’s circumanal wiring is quick and easy to perform with no formidable morbidity. The patient satisfaction is high and it can always be proposed to patients whose general status does not allow a surgical cure in complete rectal prolapse.