Name of the Procedure:

Graft (Thiersch operation) for Rectal Incontinence and/or Prolapse

Summary

The Thiersch operation is a surgical procedure designed to treat rectal incontinence and rectal prolapse by using a synthetic or biological graft to support and reinforce the rectum and anus.

Purpose

• Medical Condition: Rectal incontinence (inability to control bowel movements) and rectal prolapse (when part of the rectum protrudes from the anus).
• Goals/Outcomes: To improve bowel control and prevent the rectum from protruding, thereby improving the patient's quality of life.

Indications

• Chronic rectal incontinence unresponsive to non-surgical treatments.
• Rectal prolapse where conservative management has failed.
• Patients experiencing significant discomfort, hygiene issues, or social embarrassment due to these conditions.

Preparation

• Pre-Procedure Instructions: Patients may need to fast for 12 hours before surgery. It may be necessary to adjust current medications, particularly blood thinners.
• Diagnostic Tests: Anal manometry, defecography, or colonoscopy may be performed to assess the severity of the condition.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: The surgeon makes a small incision around the anal opening.
3. Graft Placement: A synthetic band or biologic material is inserted around the anal canal.
4. Securing the Graft: The ends of the graft are tied together under moderate tension to support the rectal muscles.
5. Closure: The incision is closed with sutures.

Special Equipment:

• Synthetic band or biologic graft
• Surgical instruments for incision and suturing

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or surgical center.

Personnel

• Surgeon
• Anesthesiologist
• Surgical Nurses
• Assistants (if needed)

Risks and Complications

• Common Risks: Infection, bleeding, pain at the incision site.

• Rare Risks: Graft rejection, damage to surrounding tissues, recurrence of prolapse or incontinence, complications related to anesthesia.

  Management of complications typically involves antibiotics for infections, pain management strategies, and potential revision surgery if the graft fails.

Benefits

• Significant improvement in the control of bowel movements.
• Relief from prolapse symptoms.
• Enhanced quality of life and social confidence.

Benefits are often noticed within a few weeks post-surgery.

Recovery

• Post-Procedure Care: Pain management with medications, wound care, avoidance of heavy lifting, and prescribed diet for bowel regulation.
• Expected Recovery Time: Typically, 2 to 4 weeks, with some restrictions on physical activities.
• Follow-Up: Regular follow-up appointments to monitor recovery and the function of the graft.

Alternatives

• Conservative treatments such as dietary changes, medications, pelvic floor exercises.

• Other surgical options like rectopexy or sphincteroplasty.

  Each alternative varies in effectiveness, risks, and recovery time.

Patient Experience

• During the Procedure: Patients will be under anesthesia and should feel no discomfort.
• Post-Procedure: Mild to moderate pain managed by medications, with some discomfort while sitting. Gradual improvement in rectal control and reduction of prolapse symptoms.

Pain management includes prescribed oral pain relievers and comfort measures such as warm sitz baths.