Rectal Prolapse Thiersch Wiring

Rectal prolapse Thiersch wiring

Thiersch wiring: This is the insertion of a non-absorbent wire, band, or synthetic substance around the anus underneath the skin to make the anal orifice become narrower.

This does not allow the rectum to prolapse but still leaves it to allow the passage of stool. It does not fix the source of prolapse but gives mechanical assistance.

Who is it recommended For?

Thiersch wiring is in common use in:

• Recurrent rectal prolapse in children.
• Elderly or frail patients
• Patients who are not fit to have an abdominal surgery.
• Preoperative management till permanent operation.
• Prolapse reoccurring after other interventions.

Benefits of Thiersch Wiring

• Minimally invasive
• Short procedure time
• May be performed as local anesthesia.
• Suitable in case of high-risk patients.
• Reduced initial complication rate.

Thiersch wiring procedure

Thiersch wiring is a perineal procedure of a simple nature to treat rectal prolapse by reducing the size of the anal orifice such that the rectum does not stick out when straining.

Indications

• Repeated rectal prolapse (particularly children)
• Older or vulnerable patients.
• Patients who are not fit to undergo a major abdominal surgery.
• Interim or palliative care.

Preparation before Surgery

• Clinical diagnosis 
• Bowel preparation (typically gentle enema)
• Stool softeners began pre-operative.
• Prophylactic antibiotics
• Anaesthesia team recommended fasting.

Thiersch Wiring Procedure

Anaesthesia

• Local anaesthesia (most popular)
• Spinal or general anaesthesia on demand.

Patient Position

• Lithotomy position

Reduction of Prolapse

• Prolapse rectum is reduced manually.
• Mucosal injury is prevented by lubrication.

Skin Incisions

• Circumferential stab incisions, 2 -4 made around the anus.
• Incisions are subcutaneous (below the skin).

Placement of Wire/Band

The anal canal is circled with a non-absorbable substance passed subcutaneously:

• Stainless steel wire
• Nylon tape
• Silastic band
• Prolene suture
• The material is a full circle around the anus.

Tightening

• The wire/band is also tightened.
• Purpose: permit finger passage to enable the flow of stool.
• Do not over tighten to avoid obstruction.

Fixation & Closure

• Wire ends are either twisted or knotted.
• Knots buried beneath skin
• Cuts on the skin sewn up.

Duration & Hospital Stay

• 20–30 minutes
• Day-care or 1-day hospital stay

Post-Procedure Care

• Stool softeners & laxatives
• Diet and hydration: high amounts of fiber.
• Sitz baths for comfort
• Avoid heavy and straining lifting.
• Periodic adjustment of wires.

Recovery

• Mild pain for a few days
• Resume normal functioning within 2-3 days.
• Full healing in 2–3 weeks

Thiersch wiring recovery

Recovery following Thiersch is normally fast and straightforward particularly as opposed to significant rectal prolapse surgeries. Most patients return to their normal life in a few days.

Early (the First 24-48 Hours) Recovery

• Mild pain, tightness or discomfort of the anus. 
• Perirectal edema.
• Light bowel movement problem.
• Typically same day discharge or 1-day hospitalization.
• Pain management: painkillers are normally enough with the use of oral painkiller.

First Week After Surgery

• Suffering slowly diminishes.
• Stool softener makes it easy to have a bowel movement.
• Sitz baths (warm water) are utilized to reduce discomfort and swelling. 
• Light walking is encouraged
• Do not strain, squat and lift heavily.

Diet During Recovery

• Whole grains are rich in fiber.
• Adequate fluids 
• Take stool softeners or weak laxatives when given.
• In the beginning, avoid spicy, oily, or constipating food.

Recovery Timeline

• Pain relief: 3–5 days
• Normal functioning of body: 3-7 days.
• Complete healing: 2–3 weeks

Thiersch wiring complications

Generally the Thiersch wiring is a safe and minimally invasive surgery, however, as with all surgeries there are complications that can arise including tightness of the wire, leaving the wire in place, and poor bowel care.

Early Complications

• Pain and Anal Tightness
• Difficulty in Passing Stool
• Bleeding
• Infection

Late Complications

• Wire Erosion
• Wire Breakage or Loosening
• Anal Stenosis
• Recurrence of Rectal Prolapse
• Fecal Impaction
• Perianal Skin Problems

Rare Complications

• Abscess formation
• Sepsis (very rare)
• Incontinence (usually temporary)

Best hospital for Thiersch wiring India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Thiersch wiring is a basic, least invasive and fast process, which offers successful short term management of rectal prolapse particularly in children, older patients, and individuals who cannot go through a major operation. It operates to prolapse the anus by mechanical support and restraint of the anus during straining. Although the surgery is safe and relatively tolerable, it does not address the cause of rectal prolapse. Consequently, it can lead to recurrence and complications with wires (e.g. pain, infection, or erosion) especially in adults, or with prolonged usage. Where there is appropriate patient choice, proper tension of the wire, excellent bowel management, and follow-up Thiersch wiring can be a good supportive or temporary treatment modality. Definitive abdominal or perineal prolapses surgeries must be done when the condition and fitness of the patient permits.

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FAQ

1. Is Thiersch wiring a lasting remedy of rectal prolapse?

• No. It mechanically regulates prolapse but leaves the causative agent. It may reoccur particularly in adults.

2. Are the patients normal with regard to passing stool?

• Yes. The wire is strained to permit passage of stool. The use of stool softeners is also necessary to prevent straining.

3. Is Thiersch wiring painful?

• The slight pain or stiffness is usual and lasts several days. Pain that is severe could be an indication that it is too tight and this should be reported.

4. Can the wire be removed later?

• Yes. In case of complications or in case the prolapse corrects (as in children) the wire can be easily taken away.

5. Does Thiersch wire improve upon abdominal rectopexy?

• No. The long-term outcomes of abdominal rectopexy are more favorable but it is more invasive. Thiersch is wiring used with high-risk or weak patients.

6. Is it possible to repeat Thiersch wiring?

• Yes, one may repeat it in case of necessity, but definite surgery can be prescribed in case of recurrent one.