ADDITION OF ANAL ENCIRCLEMENT TO PERINEAL PROCTOSIGMOIDECTOMY: A RETROSPECTIVE REVIEW
Aiya Amery*, Nathan Ginther, Dilip Gill
University of Saskatchewan, Saskatoon, SK, Canada
Purpose: Rectal procidentia, or prolapse, is a benign, but debilitating condition that disproportionately affects women (9:1) commonly in their seventh decade of life.<font size="1"> </font>There are countless operations and combinations described, however there is no standard approach. Successful outcomes in rectal prolapse surgery include prevention of recurrence and improvement in functional outcomes. Although associated with higher recurrence, perineal approaches are preferred in elderly and high-risk patients. Perineal rectosigmoidectomy (Altemeier) is one of the most common, well-tolerated perineal approach. However, its recurrence rates are up to 58%. Anal encirclement (Thiersch) is an alternative approach to mechanically restrict the lumen, but its recurrence rates are also up to 50%. We hypothesize that combining these approaches would reduce the recurrence of rectal prolapse.
Methods: This was a single institution (Royal University Hospital, SK), retrospective analysis from July 2017-October 2022. Patients >18 years of age with a rectal prolapse who underwent an operation with either an Altemeier or Altemeier +Thiersch where included. Rectal prolapse was defined as circumferential, full-thickness protrusion of the rectal wall through the anal verge. Variables were analyzed using Pearson's Chi-squared Test or Man Whitney-U Test as appropriate. Repeated measurement ANOVA was used to compare changes. A p-value of <0.05 was considered significant. All data was analyzed using SPSS v.28 (IBM Corp, Armonk, NY). Recurrence was the primary outcome measured. Secondary outcomes were operative time, length of hospital stay, and complications.
Results: Twenty-three patients underwent an Altemeier, and twenty-one patients underwent Altemeier + Thiersch. The two groups had similar demographics, including average age, BMI, gender, ASA, and length of prolapse (Table 1). Patients who received the combined procedure had a lower rate (9.5%) of recurrent rectal prolapse, despite a higher proportion of them having had a previous prolapse procedure, than the Altemeier group alone (34.8%). This reduction in the incidence of recurrence was statistically significantly, p 0.023 (Table 1). There was no statistical difference in the average OR time between the two groups. The average hospital stay for patients who underwent the combined procedure was 2.3 days less (p 0.031). There were 5 complications in the Altemeier group compared to the combined group, however this difference was not statistically significant (Table 2).
Conclusion: The combination of an Altemeier + Thiersch reduces the risk of rectal prolapse recurrence than an Altemeier alone. It is safe and is effective in patients with a history of previous failed prolapse procedures.
Table 2: Outcomes
Table 1: Demographics
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