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.