title: Bio-Thiersch as an Adjunct to Perineal Proctectomy Reduces Rates of Recurrent Rectal Prolapse.
abstract: BACKGROUND
  The rates of recurrent prolapse after perineal proctectomy vary widely in the literature, with incidences ranging between 0% and 50%. The Thiersch procedure, first described in 1891 for the treatment of rectal prolapse, involves encircling the anus with a foreign material with the goal of confining the prolapsing rectum above the anus. The Bio-Thiersch procedure uses biological mesh for anal encirclement and can be used as an adjunct to perineal proctectomy for rectal prolapse to reduce recurrence.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the Bio-Thiersch procedure as an adjunct to perineal proctectomy and its impact on recurrence compared with perineal proctectomy alone.
  
  
  METHODS
  A retrospective review of consecutive patients undergoing perineal proctectomy with and without Bio-Thiersch was performed.
  
  
  METHODS
  Procedures took place in the Division of Colon and Rectal Surgery at a tertiary academic teaching hospital.
  
  
  METHODS
  Patients who had undergone perineal proctectomy and those who received perineal proctectomy with Bio-Thiersch were evaluated and compared.
  
  
  METHODS
  All of the patients with rectal prolapse received perineal proctectomy with levatorplasty, and a proportion of those patients had a Bio-Thiersch placed as an adjunct.
  
  
  METHODS
  The incidence of recurrent rectal prolapse after perineal proctectomy alone or perineal proctectomy with Bio-Thiersch was documented.
  
  
  RESULTS
  Sixty-two patients underwent perineal proctectomy (8 had a previous prolapse procedure), and 25 patients underwent perineal proctectomy with Bio-Thiersch (12 had a previous prolapse procedure). Patients who received perineal proctectomy with Bio-Thiersch had a lower rate of recurrent rectal prolapse (p < 0.05) despite a higher proportion of them having had a previous prolapse procedure (p < 0.01). Perineal proctectomy with Bio-Thiersch had a lower recurrence over time versus perineal proctectomy alone (p < 0.05).
  
  
  CONCLUSIONS
  This study was limited by nature of being a retrospective review.
  
  
  CONCLUSIONS
  Bio-Thiersch as an adjunct to perineal proctectomy may reduce the risk for recurrent rectal prolapse and can be particularly effective in patients with a history of previous failed prolapse procedures.
authors.affiliation: 1 Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois 2 Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois.
authors.forename: Saleh M
authors.initials: SM
authors.lastname: Eftaiha
authors.forename: Jed F
authors.initials: JF
authors.lastname: Calata
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Sugrue
authors.forename: Slawomir J
authors.initials: SJ
authors.lastname: Marecik
authors.forename: Leela M
authors.initials: LM
authors.lastname: Prasad
authors.forename: Anders
authors.initials: A
authors.lastname: Mellgren
authors.forename: Johan
authors.initials: J
authors.lastname: Nordenstam
authors.forename: John J
authors.initials: JJ
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D001705:Bioprosthesis; D016022:Case-Control Studies; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome