Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case report
Abstract Background Treatment options for complete rectal prolapse include over 100 procedures. In previous reports, operative rectal prolapse repair, regardless of the technique by perineal approach, was associated with high recurrence rates. However, there is no consensus on the optimal surgical p...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Japan Surgical Society
2021-09-01
|
| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40792-021-01287-4 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850053614398078976 |
|---|---|
| author | Teppei Kamada Hironori Ohdaira Junji Takahashi Yoshinobu Fuse Wataru Kai Keigo Nakashima Yuichi Nakaseko Norihiko Suzuki Masashi Yoshida Takeo Usui Yutaka Suzuki |
| author_facet | Teppei Kamada Hironori Ohdaira Junji Takahashi Yoshinobu Fuse Wataru Kai Keigo Nakashima Yuichi Nakaseko Norihiko Suzuki Masashi Yoshida Takeo Usui Yutaka Suzuki |
| author_sort | Teppei Kamada |
| collection | DOAJ |
| description | Abstract Background Treatment options for complete rectal prolapse include over 100 procedures. In previous reports, operative rectal prolapse repair, regardless of the technique by perineal approach, was associated with high recurrence rates. However, there is no consensus on the optimal surgical procedure for relapsed rectal prolapse. Case presentation A 97-year-old woman was admitted to our hospital with a chief complaint of complete rectal prolapse measuring > 5 cm. The patient had a history of laparoscopic anterior suture rectopexy without sigmoid resection under general anesthesia for complete rectal prolapse one year prior. The patient’s postoperative course was uneventful. However, her dementia worsened (Hasegawa’s dementia scale: 5/30 points) after the first operation. Further, moderate-to-severe aortic valve stenosis was first diagnosed with heart failure 6 months after the operation. Nine months after the initial surgery, she experienced a recurrence of complete rectal prolapse measuring approximately 5 cm. Considering the coexistence of advanced age, severe dementia, and aortic valve stenosis, surgery under general anesthesia was not indicated. Perineal stapled prolapse resection in combination with the t operation was planned because of its minimal invasiveness and shortened hospital stay. The procedure was performed by a team of two surgeons in the jack knife position, under spinal anesthesia. The prolapse was cut along the long-axis direction with three linear staplers and resected along the short-axis direction with four linear staplers. The cross-section of the linear stapler was reinforced with 3-0 Vicryl sutures. After rectal resection, the Thiersch operation using 1-0 nylon thread 1 cm away from the anal verge was additionally performed. The operative time was 24 min, and intraoperative blood loss was 1 mL. The postoperative course was uneventful. Three months after the operation, no recurrence was observed, and defecation function was good with improvements of Wexner score. Conclusions Perineal stapled prolapse resection in combination with the Thiersch operation could be a useful option for patients with relapsed rectal prolapse and with poor general condition, who are not indicated for other surgical procedures. |
| format | Article |
| id | doaj-art-96dae7a38e2b4ef8926f59ce8ccca086 |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2021-09-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-96dae7a38e2b4ef8926f59ce8ccca0862025-08-20T02:52:28ZengJapan Surgical SocietySurgical Case Reports2198-77932021-09-01711510.1186/s40792-021-01287-4Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case reportTeppei Kamada0Hironori Ohdaira1Junji Takahashi2Yoshinobu Fuse3Wataru Kai4Keigo Nakashima5Yuichi Nakaseko6Norihiko Suzuki7Masashi Yoshida8Takeo Usui9Yutaka Suzuki10Department of Surgery, International University of Health and Welfare HospitalDepartment of Surgery, International University of Health and Welfare HospitalDepartment of Surgery, International University of Health and Welfare HospitalDepartment of Surgery, International University of Health and Welfare HospitalDepartment of Surgery, International University of Health and Welfare HospitalDepartment of Surgery, International University of Health and Welfare HospitalDepartment of Surgery, International University of Health and Welfare HospitalDepartment of Surgery, International University of Health and Welfare HospitalDepartment of Surgery, International University of Health and Welfare HospitalDepartment of Orthopedics, Nasu Central HospitalDepartment of Surgery, International University of Health and Welfare HospitalAbstract Background Treatment options for complete rectal prolapse include over 100 procedures. In previous reports, operative rectal prolapse repair, regardless of the technique by perineal approach, was associated with high recurrence rates. However, there is no consensus on the optimal surgical procedure for relapsed rectal prolapse. Case presentation A 97-year-old woman was admitted to our hospital with a chief complaint of complete rectal prolapse measuring > 5 cm. The patient had a history of laparoscopic anterior suture rectopexy without sigmoid resection under general anesthesia for complete rectal prolapse one year prior. The patient’s postoperative course was uneventful. However, her dementia worsened (Hasegawa’s dementia scale: 5/30 points) after the first operation. Further, moderate-to-severe aortic valve stenosis was first diagnosed with heart failure 6 months after the operation. Nine months after the initial surgery, she experienced a recurrence of complete rectal prolapse measuring approximately 5 cm. Considering the coexistence of advanced age, severe dementia, and aortic valve stenosis, surgery under general anesthesia was not indicated. Perineal stapled prolapse resection in combination with the t operation was planned because of its minimal invasiveness and shortened hospital stay. The procedure was performed by a team of two surgeons in the jack knife position, under spinal anesthesia. The prolapse was cut along the long-axis direction with three linear staplers and resected along the short-axis direction with four linear staplers. The cross-section of the linear stapler was reinforced with 3-0 Vicryl sutures. After rectal resection, the Thiersch operation using 1-0 nylon thread 1 cm away from the anal verge was additionally performed. The operative time was 24 min, and intraoperative blood loss was 1 mL. The postoperative course was uneventful. Three months after the operation, no recurrence was observed, and defecation function was good with improvements of Wexner score. Conclusions Perineal stapled prolapse resection in combination with the Thiersch operation could be a useful option for patients with relapsed rectal prolapse and with poor general condition, who are not indicated for other surgical procedures.https://doi.org/10.1186/s40792-021-01287-4High-risk surgeryPerineal stapled prolapse resectionRectal prolapseSurgical repairThiersch operation |
| spellingShingle | Teppei Kamada Hironori Ohdaira Junji Takahashi Yoshinobu Fuse Wataru Kai Keigo Nakashima Yuichi Nakaseko Norihiko Suzuki Masashi Yoshida Takeo Usui Yutaka Suzuki Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case report Surgical Case Reports High-risk surgery Perineal stapled prolapse resection Rectal prolapse Surgical repair Thiersch operation |
| title | Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case report |
| title_full | Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case report |
| title_fullStr | Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case report |
| title_full_unstemmed | Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case report |
| title_short | Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case report |
| title_sort | perineal stapled prolapse resection in combination with thiersch operation for relapsed rectal prolapse a case report |
| topic | High-risk surgery Perineal stapled prolapse resection Rectal prolapse Surgical repair Thiersch operation |
| url | https://doi.org/10.1186/s40792-021-01287-4 |
| work_keys_str_mv | AT teppeikamada perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport AT hironoriohdaira perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport AT junjitakahashi perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport AT yoshinobufuse perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport AT watarukai perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport AT keigonakashima perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport AT yuichinakaseko perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport AT norihikosuzuki perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport AT masashiyoshida perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport AT takeousui perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport AT yutakasuzuki perinealstapledprolapseresectionincombinationwiththierschoperationforrelapsedrectalprolapseacasereport |