Addition of anal encirclement to perineal proctosigmoidectomy: a retrospective review.

IF 1.6 4区医学 Q2 SURGERY Frontiers in Surgery Pub Date : 2025-01-24 eCollection Date: 2025-01-01 DOI:10.3389/fsurg.2025.1492690

Aiya Amery, Kayla Marritt, Zarrukh Baig, Haven Roy, Dilip Gill, Nathan Ginther

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Abstract

Background: The optimal approach for the surgical management of rectal prolapse is individualized based on anatomical, functional, and surgical factors. In patients with significant comorbidities, perineal approaches are often preferred even though they are associated with higher recurrence rates compared to an abdominal approach. Although anal encirclement was one of the first procedures described for this condition, it is seldom employed given its high recurrence rates. There is currently a lack of data addressing a combination surgery, wherein both a perineal proctosigmoidectomy and anal encirclement are performed simultaneously.

Aims: To evaluate the efficacy of combining perineal proctosigmoidectomy with anal encirclement using Nylon sutures compared to perineal proctosigmoidectomy alone.

Methods: This was a single institution, non-randomized, retrospective study conducted at the Royal University Hospital, Saskatoon, Saskatchewan, Canada (July 2017 to October 2022). Patients over the age of 18 with full-thickness rectal prolapse who underwent either perineal proctosigmoidectomy alone or perineal proctosigmoidectomy with anal encirclement were included. There were 23 patients in the perineal proctosigmoidectomy group and 21 patients in the perineal proctosigmoidectomy with anal encirclement group. The primary outcome was prolapse recurrence. Secondary outcomes included operative time, length of hospital stay, and post-operative complications.

Results: Patients who received perineal proctosigmoidectomy with anal encirclement had significantly lower rates of recurrent prolapse (9.5%) compared to perineal proctosigmoidectomy alone (34.8%) (p = 0.02). Patients who underwent the combined procedure had a shorter length of stay by 2.3 days (p = 0.03). There was no difference in post-operative complications or operating time.

Conclusions: Routine anal encirclement in perineal proctosigmoidectomy reduces recurrence rates and length of stay without increasing operating time or complications.

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会阴乙状结肠直肠切除术中增加肛门包皮术的回顾性研究。

背景：直肠脱垂的最佳手术治疗方法是基于解剖、功能和手术因素的个体化治疗。对于有明显合并症的患者，会阴入路通常是首选，尽管与腹部入路相比，会阴入路的复发率更高。虽然肛门包围术是治疗这种疾病的第一种方法，但由于其高复发率，很少采用。目前缺乏联合手术的资料，其中会阴乙状结肠切除术和肛门包皮术同时进行。目的：评价会阴乙状结肠直肠切除术联合尼龙缝合肛环术与单纯会阴乙状结肠直肠切除术的疗效。方法：这是一项在加拿大萨斯喀彻温省萨斯卡通皇家大学医院进行的单机构、非随机、回顾性研究（2017年7月至2022年10月）。年龄在18岁以上的全层直肠脱垂患者接受了会阴乙状结肠切除术或会阴乙状结肠切除术合并肛门包皮术。会阴乙状结肠切除组23例，会阴乙状结肠切除加肛包皮组21例。主要结局为脱垂复发。次要结局包括手术时间、住院时间和术后并发症。结果：会阴乙状结肠切除术合并肛门包皮术患者复发性脱垂率（9.5%）明显低于单纯会阴乙状结肠切除术（34.8%）（p = 0.02）。接受联合治疗的患者住院时间缩短2.3天（p = 0.03）。两组术后并发症及手术时间无差异。结论：会阴乙状结肠直肠切除术常规肛包皮术可减少复发率和住院时间，且不增加手术时间和并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.