Modified Gant-Miwa approach versus modified Thiersch′s stitch for the management of rectal mucosal prolapse in children: how to decrease recurrence?

Elwan, Taher H.; Abd El-Mabood, El-Sayed A.; Ali, Hazem E.

doi:10.4103/1110-1121.141900

Modified Gant-Miwa approach versus modified Thiersch′s stitch for the management of rectal mucosal prolapse in children: how to decrease recurrence?

Authors

10.4103/1110-1121.141900

Abstract

Purposes
The aim of this study was to assess the early outcomes and advantages of a modified Gant-Miwa approach for the treatment of rectal mucosal prolapse in children and determine how this modification helps decrease recurrence when compared with modified Thiersch's stitch in a prospective and randomized setting.
Background
Recurrence of rectal mucosal prolapse after rectal mucosal prolapse repair through the anus represents a problem for the surgeon and the patient. Although there are many trials to prevent this recurrence, a definite solution has not been found yet.
Patients and methods
The study included 60 children with rectal mucosal prolapse (mean age 3.6 ± 1.2 years) who were divided into two groups: group A ( = 30), comprising patients who underwent the modified Gant-Miwa operation, and group B ( = 30), comprising patients who underwent a modified Thiersch's prolene stitch.
Results
The modified Gant-Miwa operation was a successful approach with which to decrease constipation [2.0 (6.6%) vs. 9.0 (30%) cases; < 0.05] and recurrence [1.0 (3.3%) vs. 5 (16.6%); = 0.0002] to a great extent, although it was followed by more anal soiling in the first 2 weeks (11.3 ± 0.7 vs. 3.7 ± 0.2; > 0.05).
Conclusion
The modified Gant-Miwa operation was a successful approach for decreasing early postoperative morbidity, especially constipation and recurrence, and thus incidences of surgical redo because of complications were also fewer, despite it being associated with more anal discharge especially in the first 2 weeks.

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