Modified Gant–Miwa–Thiersch procedure (mucosal plication with anal encircling) for rectal prolapse

Iida, Yoshiro; Honda, Kôtarô; Saitou, Hajime; Munemoto, Yoshinori; Tanaka, Hiroyuki

doi:10.1111/codi.14565

Cited by 11 publications

(23 citation statements)

References 7 publications

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“…One surgical technique for FTRP is the Gant-Miwa-Thiersch procedure (GMT) (mucosal plication with anal encircling). It can be used irrespective of the length of the rectum and colon prolapse [4]. Iida et al…”

Section: Discussionmentioning

confidence: 99%

“…reported that there were no postoperative complications out of 166 patients who underwent GMT. GMT is not popular in Europe and the United States, while it plays a major role in the treatment of rectal prolapse in China and Japan [4][5]. Possible reasons include anatomical and dietary factors.…”

Section: Discussionmentioning

confidence: 99%

“…These include Delorme's operation, Altemeier's operation, stapled transanal rectal resection (STARR), and Gant-Miwa-Thiersch (GMT). The GMT procedure is the most common treatment in China and Japan [4][5]. However, the recurrence rates of GMT are as high as 23.8% [4].…”

Section: Introductionmentioning

confidence: 99%

“…The GMT procedure is the most common treatment in China and Japan [4][5]. However, the recurrence rates of GMT are as high as 23.8% [4].…”

Section: Introductionmentioning

confidence: 99%

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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

Wang

Ma³

et al. 2021

Preprint

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The GMT procedure is the most common treatment in China and Japan [4][5]. However, the recurrence rates of GMT are as high as 23.8% [4].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Wang

Ma³

et al. 2021

Preprint

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show abstract

“…Most of them were small case series. 5,6,[9][10][11] Asian populations generally show a lower body mass index (BMI) than western populations. The benefit of minimally invasive surgery is more prominent in low BMI populations.…”

mentioning

confidence: 99%

Changing Trend of Rectal Prolapse Surgery in the Era of the Minimally Invasive Surgery

Lee

2019

J Minim Invasive Surg

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With the life span of the general population increased, rectal prolapse in elderly patients became a major concern in terms of the decision of the treatment modalities and quality of life of patients. Most elderly patients with rectal prolapse in the past received a perineal approach with the fear of general anesthetic complications rather than the abdominal approach. However, improvement in perioperative care in anesthesiology and minimally invasive surgery, the trend of surgical management of rectal prolapse is rapidly changing. Minimally invasive surgery including the laparoscopic and robotic surgeries showed comparable short-term outcomes even in elderly patients. Recently published guidelines also recommended a laparoscopic abdominal approach for the management of rectal prolapse.

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A new modified Gant-Miwa-Thiersch combined with submucosal and perirectal sclerosant injection procedure for full-thickness rectal prolapse in elderly women: clinical analysis of 34 cases

Wang

et al. 2021

BMC Surg

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Background Full-thickness rectal prolapse (FTRP) frequently occurs 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 rate of FTRP post-GMT, which is 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 according to the 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, no significant difference was observed between the preoperative and postoperative Wexner constipation scores (WCS) (17.3 ± 2.25 vs. 15.4 ± 2.89, P = 0.1047). The perioperative and postoperative AST were 38.1 ± 5.34 mL and 23.5 ± 3.61 mL, respectively (P = 0.0002). The maximum rectal tolerance (MRT) was 157.1 ± 16.73 mL, which became 121.2 ± 12.45 mL postoperatively (P = 0.0009). The patients developed no serious postoperative complications. The total relapse rate after nmGMTSI was 2.9% in the median two 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 rates of recurrence, complications, and mortality, cost-effectiveness, wide adaptation, minimal invasiveness, and technical simplicity. Hence, it should be considered the first option for the treatment of FTRP in frail elderly women.

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Modified Gant–Miwa–Thiersch procedure (mucosal plication with anal encircling) for rectal prolapse

Cited by 11 publications

References 7 publications

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

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

Changing Trend of Rectal Prolapse Surgery in the Era of the Minimally Invasive Surgery

A new modified Gant-Miwa-Thiersch combined with submucosal and perirectal sclerosant injection procedure for full-thickness rectal prolapse in elderly women: clinical analysis of 34 cases

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