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

Step 1: Analyze the image.
The image shows a stepwise surgical technique (steps A, B, C) involving the anal region where a suture or prosthesis is placed circumferentially around the anus, forming a narrowing ring.

Step 2: Match the technique to the operation.

• Thiersch wiring (Thiersch procedure / Anal encirclement): A simple palliative operation for rectal prolapse where a wire, nylon suture, or silastic sling is placed subcutaneously around the anus to narrow the anal opening and prevent prolapse. Performed in elderly or high-risk patients who cannot tolerate major surgery. The sequential steps in the image precisely depict this technique.
• Wells procedure: posterior rectopexy using a polyvinyl alcohol (Ivalon) sponge sutured to the presacral fascia -- involves abdominal approach, no anal encirclement.
• Aktemeier operation: a hemorrhoid-related technique -- unrelated.
• Hemorrhoidectomy: excision of hemorrhoidal tissue -- completely different from anal encirclement.

Step 3: Conclusion.
The image depicts Thiersch wiring (anal encirclement), performed for rectal prolapse in high-risk or elderly patients. It uses a suture or prosthesis to narrow the anus mechanically. It is palliative, not curative.