Department of Coloproctology, Yang Hospital, 933, Gyeongchun-ro, Namyangju-si, Gyeonggi-do, 12234, Republic of Korea.
Department of Coloproctology, Seoul Yang Hospital, Seoul, Republic of Korea.
World J Surg. 2020 Sep;44(9):3141-3148. doi: 10.1007/s00268-020-05554-7.
Conventionally, the Thiersch operation has typically involved blind positioning of the sling, and sling tension is subjectively based on a rule-of-thumb estimate. The aim of this study was to describe standardized methods for performing the Thiersch operation.
Seventeen patients with fecal incontinence underwent the calibrated method of the Thiersch procedure. As an encircling sling, a 6-mm-wide silastic tube was used. Through 4 minimal perianal skin incisions, the sling was placed proximal to the anal skin 3 cm from the anal verge and 4 cm in depth. The circumference of the sling was 10 cm in length. Results were assessed by clinical responses and by comparing pre- and postoperative Wexner scores. The data were collected retrospectively.
The median follow-up period was 9 months (range 6-19). In 16 out of 17 fecal incontinence patients (94.1%), the median Wexner incontinence score was 0 (range 0-3) postoperatively. Localized sepsis developed in three cases (17.7%, 3/17), which were controlled with drainage and antibiotics. Fecal impaction occurred in one case (5.9%, 1/17). There was no removal or breakage of the inserted sling.
The elasticity of the silastic tube reduced the incidence of sling breakage. According to the standardized method, the sling was placed external to the external anal sphincter muscle and at the junction of the external anal sphincter muscle and puborectalis muscle. Fecal incontinence was controlled effectively, and the incidence of fecal impaction was negligible. High reproducibility was observed with this method.
传统的 Thiersch 手术通常涉及吊带的盲目定位，吊带张力是根据经验法则主观估计的。本研究旨在描述 Thiersch 手术的标准化方法。
17 例大便失禁患者接受了校准的 Thiersch 手术。作为一个环绕吊带，使用 6mm 宽的硅酮管。通过 4 个最小的肛周皮肤切口，吊带放置在肛门皮肤近端 3cm 处，深度为 4cm。吊带的周长为 10cm。通过临床反应和比较术前和术后 Wexner 评分来评估结果。数据是回顾性收集的。
中位数随访时间为 9 个月（范围 6-19）。在 17 例大便失禁患者中的 16 例（94.1%）中，术后中位数 Wexner 失禁评分为 0（范围 0-3）。3 例（17.7%，3/17）出现局部脓毒症，经引流和抗生素控制。1 例（5.9%，1/17）发生粪便嵌塞。插入的吊带没有取出或断裂。
硅酮管的弹性降低了吊带断裂的发生率。根据标准化方法，吊带放置在肛门外括约肌外部和肛门外括约肌与耻骨直肠肌交界处。有效地控制了大便失禁，粪便嵌塞的发生率可以忽略不计。该方法具有较高的可重复性。
