Coloproctology Center, Jihoukai Tanaka Hospital, Fukui, Japan.
Department of Surgery, Jihoukai Tanaka Hospital, Fukui, Japan.
Colorectal Dis. 2019 May;21(5):588-594. doi: 10.1111/codi.14565. Epub 2019 Feb 14.
Rectal prolapse (RP) is usually associated with elderly women and is well recognized as having a detrimental effect on quality of life. A number of surgical procedures for RP are available, but morbidity and mortality are substantial. The Gant-Miwa-Thiersch procedure (GMT) has been frequently used for RP in Japan. However, as GMT has a high recurrence rate it is not widely used elsewhere. The aim of this study was to evaluate a modified version of GMT (mGMT) in comparison with other procedures.
mGMT was performed under spinal or local anaesthesia in 187 patients with RP. No normal mucosa was left between the tags and lateral wounds were created in the Thiersch procedure. Morbidity, mortality and recurrence rates were recorded.
No serious postoperative complications and no operative deaths occurred after mGMT. Eight per cent of patients suffered from infection of the strings. The overall recurrence rate after mGMT was 7.5% with a median follow-up period of 13.8 years.
On the basis of these results, we consider that mGMT has a number of advantages: it is minimally invasive, does not require general anaesthesia, is technically simple to perform and is associated with satisfactory outcomes and low morbidity. mGMT should be considered an option for the treatment of RP in elderly patients.
直肠前突（RP）通常与老年女性有关，并且被认为对生活质量有不利影响。有许多用于 RP 的手术方法，但发病率和死亡率都很高。Gant-Miwa-Thiersch 手术（GMT）在日本常用于 RP。然而，由于 GMT 的复发率很高，因此在其他地方并不广泛使用。本研究旨在评估 GMT 的改良版（mGMT）与其他手术方法的比较。
在 187 例 RP 患者中，在脊髓或局部麻醉下进行 mGMT。在 Thiersch 手术中，标签之间不留正常黏膜，并在外侧形成伤口。记录发病率、死亡率和复发率。
mGMT 后无严重术后并发症和手术死亡。8%的患者发生缝线感染。mGMT 后总的复发率为 7.5%，中位随访时间为 13.8 年。
基于这些结果，我们认为 mGMT 具有许多优点：微创、无需全身麻醉、技术简单、结果满意、发病率低。mGMT 应被视为治疗老年患者 RP 的一种选择。
