Efficacy and safety of anal encirclement combining the Leeds-Keio artificial ligament with injection sclerotherapy using aluminum potassium sulfate and tannic acid in the management of rectal prolapse: a single-center observational study

Abe Tatsuya; Kunimoto Masao; Hachiro Yoshikazu; Ohara Kei; Inagaki Mitsuhiro

doi:10.3393/ac.2021.00731.0104

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자료유형: 학술저널

저자정보: Abe Tatsuya (Department of Proctology Kunimoto Hospital Asahikawa Hokkaido Japan) Kunimoto Masao (Department of Proctology Kunimoto Hospital Asahikawa Hokkaido Japan) Hachiro Yoshikazu (Department of Proctology Kunimoto Hospital Asahikawa Hokkaido Japan) Ohara Kei (Department of Proctology Kunimoto Hospital Asahikawa Hokkaido Japan) Inagaki Mitsuhiro (Department of Proctology Kunimoto Hospital Asahikawa Hokkaido Japan)

저널정보: 대한대장항문학회 Annals of Coloproctology Annals of Coloproctolgy Vol.39 No.3

발행연도: 2023.6

수록면: 210 - 215 (6page)

DOI: 10.3393/ac.2021.00731.0104

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Purpose: Perineal procedures are an important surgical option for frail and high-risk patients with rectal prolapse. This study aimed to evaluate the efficacy and safety of combined therapy using injection sclerotherapy, with aluminum potassium sulfate and tannic acid (ALTA), and the Thiersch procedure, using the Leeds-Keio ligament (ALTA-Thiersch).Methods: This study included 106 consecutive patients (mean age, 81.2 years) who underwent ALTA-Thiersch for rectal prolapse. The procedure was performed under caudal epidural anesthesia. ALTA was injected into the submucosa from the tip of the prolapsed rectum down to the dentate line, circumferentially, at 20 to 40 locations. The ligament tape was placed outside the external sphincter muscle and at an approximate depth of 2 cm into the middle anal canal.Results: Of 106 patients, rectal prolapse was cured shortly after surgery in 105 patients. An additional tape was inserted in 1 patient who had persistent prolapse. Postoperative complications were observed in 27 patients (25.5%). Fecal impaction occurred in 12 patients; however, since it was temporary, no tape removal was required. Of the 12 cases in which the tape was infected or exposed, 11 required tape removal. There were 18 cases of recurrence at a mean follow-up of 22.1 months. Cumulative recurrence rates at 3 and 5 years were 21.3% and 38.6%, respectively.Conclusion: ALTA-Thiersch is a simple and safe procedure for rectal prolapse, having reasonable outcomes. The use of the Leeds-Keio ligament for anal encircling can help compensate for the disadvantages of the Thiersch operation.

#Rectal prolapse #Sclerotherapy #Fecal impaction #Surgical wound infection #Aluminum potassium sulfate and tannic acid

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