Simple Anal Reinforcement with Anal Encirclement Using an Artificial Ligament in Patients with fecal Incontinence: A Single-center Observational Study

Outcomes of the Gant-Miwa-Thiersch Procedure Using the Leeds-Keio Mesh for Rectal Prolapse

Objectives

Several procedures are available for treating rectal prolapse (RP). This study aimed to determine the effectiveness of the Gant-Miwa-Thiersch (GMT) procedure using the Leeds-Keio mesh (LKM) as a treatment for RP.

Methods

This retrospective observational study included all patients with RP who underwent the GMT procedure using the LKM at our hospital between January 2012 and December 2023. The surgery was performed under local or lumbar spinal anesthesia in the jackknife position. The outcome measures included perioperative complications, recurrence rate, and improvement in anal function.

Results

During the study period, 107 patients with RP underwent the GMT procedure. The median patient age was 81 years, the median length of prolapse was 7 cm, and the median duration of the surgery was 39 minutes. Postoperative complications were observed in 26 (24.3%) patients, including constipation in 21, mesh early exposure in three, mesh infection in one, and bleeding in one patient(s). The median observation period was 29 months, and recurrence of RP was observed in nine (10%) out of 90 patients evaluated for recurrence, with a cumulative 5-year recurrence rate of 10.9%. Of the 65 patients with preoperative fecal incontinence, 33 (50.8%) demonstrated improvement postoperatively.

Conclusions

The GMT procedure using the LKM has a low recurrence rate. The LKM is suitable as a prosthetic material for the Thiersch procedure due to its high elasticity, which can enhance the therapeutic efficacy of the GMT procedure.

Non-ablative Erbium (YAG) and Neodymium (YAG) Laser Treatment for Anal Incontinence and Vaginal Atrophy: A Case Study

In this case study, a 68-year-old woman with anal incontinence (AI) and vaginal atrophy (VVA), who did not respond to traditional treatments such as pelvic floor exercises or hormone therapy, underwent three sessions of laser treatment using RenovaLase (SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia), which employs non-ablative Erbium:YAG and Neodymium:YAG lasers. Significant improvements were observed in the VVA symptoms, with AI being resolved. The Vaginal Health Index Score increased from 7 points at the initial assessment to 18 points at 12 months after treatment. Similarly, the Cleveland Clinic Florida Fecal Incontinence Score and St. Mark's Incontinence Score, initially at 4 points each, improved to 0 points, indicating resolution of incontinence symptoms. MRI results demonstrated vascular enhancement and growth in the anal sphincter, with the thickness of the internal anal sphincter slightly increasing from initial measurements to a maximum of 0.36 cm, and improvements in resting and squeeze pressures from 42 mmHg to 110 mmHg, respectively. These findings underscore the effectiveness of RenovaLase® laser treatment for VVA and AI symptoms, offering a novel option for pelvic floor health management in postmenopausal women, especially those resistant to the use of artificial devices for anal improvement. In the environment of hormonal decline after menopause, the atrophy of pelvic vessels leads to reduced blood flow. This situation, where a noticeable lack of blood flow occurs during pretreatment of the pelvic vessels, is addressed by laser treatment. This phenomenon has been named "re-canalization." This case suggests the potential of this therapy as an alternative for patients resistant to conventional methods involving the insertion of devices into the anus to improve fecal incontinence. Further research is needed to explore its potential benefits.