Modifications of the T.A.P.E

Professor Ahmed Farag (Cairo, Egypt)

Received 24 march 2001

I would like to congratulate you for your interesting TAPE concept. 

In fact I would like to suggest 2 modifications in order to make this interesting and global approach in management of Perineal disorders available for the majority of  those patients:

• The Gynecologic axis should be Gynecologic-Sexual axis in order to accommodate the male patients with the premature ejaculation on the positive aspect and impotence, premature ejaculation or failed ejaculation on the negative aspect. 

• On comparing the outcome of different operations e.g. comparing abdominal approaches vs. perineal approaches in repair of complete Rectocele we need a fourth axis ( Transverse axis) with the severity of the disease or the severity of the recurrence after surgery on the right side of the axis and the incidence of non-specific post operative complications on the left side of the axis. 

Fourth Axis: 

• No Rectocele = 0 ,  Mucosal prolapse = 1 & Complete prolapse = 2. 

• No complication = 0, one or more minor complications = 1 & One or more life threatening major complication = 2.

Normal Modified TAPE (OCTAGONE)

A male patient with complete rectal prolapse and partial anal incontinence (Preoperative status)  

The same patient mentioned above after perineal repair of his Rectocele with post operative mucosal prolape and postoperative wound infection.  

This is a modified TAPE of a similar male patient who had an abdominal repair of his Rectocele with complete success in repair of his prolapse and anal incontinence but he developed an iliofemoral thrombosis post-operatively and later on he had failure of ejaculation post operatively.

In fact a lot of examples of those case including simple classification of the main complaints for which perineal surgery can be done to correct can be classified into this 0-2 grading including for example:

Hemorrhoids: Grade 1-2: = 1     Grade 3-4 = 2.

Anal fistula: Low = 1   High and branched = 2.  

….etc.

Thank you again for this invaluable concept.

Prof.Dr. Ahmed Farag.MD.

Professor of General Surgery – Cairo University.

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