Tilsch's surgery

Tyre's surgery is used for surgical treatment of rectal prolapse. In 1891, Thiersch introduced silver wire into the subcutaneous tissue around the anus, tightening the relaxed sphincter and treating rectal prolapse. Later, Turell simplified the operation (Fig. 1.8.5.4-1). The advantage of this method is that the operation is simple, the damage is small, and it can be performed under local anesthesia, but this is only a kind of palliative operation, and there are certain complications, so there are not many applications. Recently, it has been proposed to use silicone rubber or nylon mesh belt, because of a certain elasticity, can expand and contract, which is beneficial to prevent fecal incontinence and rectal prolapse. Curing disease: Indication 1, the anal contraction is weak or the anus has been loose rectal prolapse. 2. Elderly and debilitating rectal prolapse. 3, often with other treatments for prolapse methods. Preoperative preparation According to the surgical requirements, prepare a 30 gauge silver wire, polyester or silicone rubber mesh belt. Surgical procedure 1. Make a 3cm long curved incision 1~2cm from the anal margin in the anterior median position, and cut the subcutaneous fascia. 2, with curved vascular clamp, around the anal canal blunt separation to the perineal shallow, deep muscle. 3, the left finger is inserted into the rectum, the right finger continues to bluntly separate to the pelvic floor (male in the lower edge of the prostate, female in the lower edge of the cervix), the right finger is separated from the left and right sides of the anal canal, each to make a tunnel. 4. Change the left hand glove, make a 2cm long longitudinal incision between the coccyx and the anal verge, and use the curved vascular clamp to bluntly separate the external sphincter muscle space to the anal ligament. 5, use the right finger to enter the posterior rectal space, separate the two sides of the anal canal, each make a tunnel, into a ring, so that it can pass the indicator. 6. Using a large curved vascular clamp to enter from the anterior incision, through the right tunnel, pierce from the posterior incision, clamp one end of the polyester mesh belt, and draw it out from the anterior incision. 7. According to the same method, the other end of the polyester mesh belt, from the rear incision, through the left tunnel, from the front incision flat out, will meet the front incision. 8, the large anus mirror (diameter 2 ~ 2, 5cm) inserted into the anal canal, as the basis of the size of the postoperative anal canal, tighten the mesh belt around the anoscope, the ends overlap 1cm, use the silk to make the mesh two Intermittent suture, then remove the anoscope. 9. Pull the front and back incisions with the hooks, and fix the number of needles on the upper and lower poles of the mesh with the muscle wall of the intestinal wall with the non-absorption line to prevent the mesh belt from being displaced and folded. 10. Finally, the tissue around the anal canal and the skin are sutured layer by layer with the gut and the fine non-absorbent line. complication 1. If the infection is serious under subcutaneous infection, the polyester mesh belt should be taken out. 2, fecal impaction and the anal ring is too tight, generally should not be less than the index finger. The use of anal canal expansion and enema can solve the fecal impaction.

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