Question

What surgery is shown here in the image?

• A. Thiersch wiring
• B. Wells procedure
• C. Aktemeier operation
• D. Hemorrhoidectomy

Hint:

The image shows a circumferential structure being placed around the anus -- think of the operation used for rectal prolapse in elderly high-risk patients.

Answer 1

The Correct Option is A

Surgical procedures for rectal prolapse -- identification approach:

The image demonstrates a sequential three-step technique (A, B, C) where a ring-like structure is placed circumferentially around the anal orifice to narrow it.

Rectal Prolapse Surgery Classification:

Perineal approaches (for high-risk or elderly patients):
- Thiersch wiring / Anal encirclement: A silver wire, nylon suture, or silastic sling placed subcutaneously around the anus to mechanically prevent prolapse by narrowing the anal canal. This is exactly what is depicted in the image.
- Delorme procedure: mucosal sleeve resection + plication of rectal musculature
- Altemeier procedure: perineal rectosigmoidectomy

Abdominal approaches (for fit patients):
- Wells procedure: posterior rectopexy with Ivalon sponge
- Frykman-Goldberg: sigmoid resection + rectopexy
- Ripstein procedure: anterior rectopexy with mesh

The image of encirclement precisely matches Thiersch wiring. It is a palliative procedure -- recurrence is common but it provides symptomatic relief in frail patients.

\[\boxed{\text{Thiersch Wiring}}\]