Rectal prolapse in children: Laparoscopic suture rectopexy is a suitable alternative (original) (raw)
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Journal of laparoendoscopic & advanced surgical techniques. Part A, 2015
Several techniques have been described for the surgical correction of rectal prolapse without any clear advantage for one technique over the other. We evaluated the use of laparoscopic suture rectopexy (LSRP) as a modality of treatment for rectal prolapse in children. Prospective data were collected for all children who presented to our center between 2011 and 2014 and required surgery for rectal prolapse. All children underwent LSRP with fixation of the mobilized rectum to the sacral promontory with multiple nonabsorbable sutures. The median follow-up period was 14 months (range, 6-29 months). The operative time, operative complications, length of hospital stay, and postoperative complications were recorded and analyzed. Seventy-four patients presented with rectal prolapse during this period. Twenty patients (27%) required LSRP. Their median age at surgery was 4.4 years (range, 2-11 years), median operative time was 77.5 minutes (range, 30-150 minutes), and the median length of hos...
15-Year experience in the treatment of rectal prolapse in children
Journal of Pediatric Surgery, 2010
Background: Rectal prolapse is a common and usually self-limited condition in children. Several surgical techniques have been advocated for refractory prolapse. We reviewed our experience with treatment and the outcome of refractory rectal prolapse. Methods: Retrospective review was conducted on patients undergoing surgery for rectal prolapse from January 1993 to March 2009. Patients with imperforate anus/cloacal abnormalities, Hirschsprung disease, spina bifida, or prior pull-through were excluded. Results: Twenty patients underwent 23 procedures for rectal prolapse. There were 10 posterior sagittal rectopexies, 6 transabdominal rectopexies, 5 laparoscopic rectopexies, 1 hypertonic saline injection, and 1 anal cerclage. The mean duration of symptoms was 1.6 years (range, 1-10 years). The mean age at operation was 6.8 years (range, 4 months-19 years), with a 5:1 male predominance. There was no operative or perioperative mortality. Median length of follow-up was 7.2 months; 2 patients were lost to follow-up.
Laparoscopic suture rectopexy in the treatment of persisting rectal prolapse in children
Surgical Endoscopy, 2006
Background: The repair of choice for persistent rectal prolapse (PRP) in children is disputed. Laparoscopic suture rectopexy (LSRP) is effective in adults, but its usefulness in pediatric PRP is unknown. We compared LSRP with posterosagittal rectopexy (PSRP). Methods: Sixteen children, with a median age of 6.5 years (range, 0.8-16.8) and duration of symptoms of 2.8 years (range, 0.5-10.2), underwent surgery for PRP. Eight (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000) had PSRP, and eight (2002)(2003)(2004)(2005) had LSRP. Three patients with LSRP were healthy; the others had mental retardation and epilepsy (n = 1), cerebral palsy (n = 1), AspegerÕs syndrome (n = 1), meningomyelocele (n = 1), and bladder extrophy (n = 1). Preoperative cologram (n = 6), sigmoideoscopy (n = 3), and anorectal manometry (n = 2) were normal in patients with LSRP. In LSRP, the rectum was mobilized and sutured to the sacral periosteum. Results: Median operation time for LSRP was 80 min (range, 62-90) and for PSRP 40 min (range, 25-70) (p < 0.05); median hospital time was 6 days (range, 3-8) for LSRP and 6 days (range, 3-9) for PSRP (not significant). Six patients with LSRP had a median follow-up of 13 months (range, 4-24). None have had recurrences, and two patients (33%) require laxatives. Of the patients with PSRP, two (25%) had recurrence and underwent abdominal rectopexy with sigmoid resection. Conclusion: Medium-term results indicate that LSPR is effective in pediatric PRP. Constipation is the only postoperative problem in a significant proportion of patients.
Mini-invasive Surgery
Mini-invasive Surgery www.misjournal.net Aim: Rectal prolapse in children is a common condition in infancy and early childhood that usually responds to conservative measures. Surgery is reserved only for resistant cases that fail to respond to conservative measures. This study was designed to evaluate the efficacy of 3-point fixation concept (retrorectal dissection, rectopexy to presacral fascia of the sacral promontory and sigmoidopexy onto the anterior abdominal wall) in treatment of complete rectal prolapse in children using laparoscopy. Methods: This prospective study was conducted on 12 children with persistent complete rectal prolapse who failed to respond to adequate conservative measures from July 2015 to July 2016. The technical details of the procedure are described. Patients were followed up for at least 6 months and were assessed clinically and radiologically for continence and constipation using the appropriate scoring systems. Results: Twelve patients were included, 8 females and 4 males, laparoscopic rectopexy and sigmoidopexy were done for all cases. The mean duration for surgery was 58.42 min. No intraoperative complications recorded. One case (8.3%) had partial thickness recurrence and 1 case had skin stitch sinus. No postoperative constipation nor incontinence was observed. Conclusion: The laparoscopic rectopexy and sigmoidopexy is an effective approach for the treatment of refractory complete rectal prolapse in children. The 3-point fixation proved efficient in controlling rectal prolapse in children with minimal complications.
Management of rectal prolapse in children: Ekehorn's rectosacropexy
Journal of Pediatric Surgery, 2000
Although surgical intervention is occasionally required for rectal prolapse (RP), there is both vagueness as to the indications for surgery and confusion as to the technique that should be used for children who need surgical treatment. Using Ekehorn's transanal suture rectosacropexy technique, 56 children with RP were treated surgically between 1987 and 1998 at our hospital. There were 36 boys and 20 girls, the average age was 4.5 years, and the duration of the recurrent prolapse prior to admission ranged from 3 to 8 months. The technique consists of simply inserting one``U''-shaped suture through the rectal ampulla and tying the strands of the suture outside at the level of the sacrococcygeal junction. In this series, follow-up periods ranged from 1 to 10 years and there were no recurrences. We believe that surgical indications for RP need to be de®ned more clearly and that Ekehorn's technique oers a simple and eective method for the surgical treatment of complete RP in children.
Reappraisal of Ekehorn's rectopexy in the management of rectal prolapse in children
Journal of Pediatric Surgery, 1993
An old and simple operative technique for the treatment of rectal prolapse in children, first described by Ekehorn' in 1909, has been reviewed. The technique consists of the insertion of a mattress suture (nonabsorbable and multifilament material) in the rectal ampulla through the lowermost part of the sacrum: the strands of the mattress suture are tied firmly over a piece of dry gauze at the level of the sacrococcygeal junction. By leaving the suture in place for 10 days, the local inflammation and infection causes firm adhesions between the rectal wall and the perirectal tissue so that the anorectal wall is bound to the surroundings (sacrorectopexy). The results of this retrospective study on 22 patients proves that this form of transsacral rectopexy in the management of rectal prolapse in children is effective (100%). simple and without complications compared to other techniques. There were no recurrences and no major morbidity. The overall surgical treatment of rectal prolapse in children is briefly reviewed.
Minimally Invasive Surgery, 2020
Purpose. To compare laparoscopic mesh rectopexy with laparoscopic suture rectopexy. Patients and Methods. The prospective study was conducted at Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt between Feb 2010 and Jan 2015. Seventy-eight children with persistent complete rectal prolapse were subjected to laparoscopic rectopexy. Fourteen parents refused to participate. All patients received initial conservative treatment for more than one year. The remaining 64 patients were randomized divided into two equal groups. Group A; 32 patients underwent laparoscopic mesh rectopexy and group B, 32 underwent laparoscopic suture rectopexy. The operative time, recurrence rate, post-operative constipation, and effect on fecal incontinence, were reported and evaluated for each group. Results. Sixty-four cases presented with persistent complete rectal prolapse were the material of this study. They were 40 males and 24 females. Mean age at operation was 8 (5–12) years. All...
Journal of Pediatric Surgery, 2010
Background/Purpose: Our approach to full-thickness anorectal prolapse has transitioned to laparoscopic suture rectopexy (LSRP). The purpose of this study was to describe the indications, technique, and postoperative outcomes for LSRP. Methods: Rectopexy was performed using 3 or 4 laparoscopic ports. Redundant rectum was retracted from the pelvis, and the posterior rectal wall was secured to the sacral promontory using 3 permanent sutures. Results: Nineteen children (7 girls) underwent LSRP from March 2003 to January 2008. Mean age was 6.2 ± 3.6 years. Three patients had prior perineal operations: 2 sacrococcygeal teratoma resections and 1 pull-through for Hirschsprung disease. One patient had cystic fibrosis, and another had Prader-Willi syndrome. The remaining children had either chronic constipation or idiopathic prolapse. All patients were treated preoperatively with laxatives. Two patients received antegrade continent enemas. Length of stay was 1 ± 0.8 days, with only the first 5 patients admitted to the hospital. The patient with Prader-Willi syndrome had a full-thickness recurrence (5%) owing to obsessive-compulsive behavior. Partial mucosal prolapse occurred in 2 patients. There were no other complications. Conclusions: Laparoscopic suture rectopexy is an effective minimally invasive method to treat fullthickness rectal prolapse in children from various etiologies. It can be performed as an outpatient procedure with minimal morbidity and low recurrence rate (5%).
Rectal Prolapse in Children: Experience in 67 Cases
Acta Medica Iranica, 2003
Rectal prolapse is a relatively common disease of children and is defined as a rectal mucosa protrusion or a fullthickness protrusion (all layers) from anus. The purpose of this retrospective study is the review of different surgical techniques used in our centers and recommendations for optimal surgical management of rectal prolapse. This study was based on a 19 years experience in rectal prolapse management at Amir Kabir and Bahrami hospitals. In a total number of 67 cases sclerotherapy by 5% phenol in glycerin was the chosen procedure used. Since rectal prolapse is a self limiting disease and due to the fact of good results obtained from this technique with low morbidity, low cost and easy management, we recommend sclerotherapy for surgical treatment of rectal prolapse in pediatric age group.
Rectal prolapse in children: a study of 71 cases
Gastroenterology Review, 2015
Prolapse of the rectum is the herniation of the rectum through the anus, which may be categorised as mucosal or complete. To evaluate the clinical manifestation, treatment, and surgical complications of children with rectal prolapse over a 6-year period. This study was carried out on children aged &amp;lt; 14 years who were admitted or referred for rectal prolapse that failed to respond after medical treatment in Imam Khomeini and Abouzar Children&amp;#39;s Hospital. Duration of the study was 6 years starting in March 2002. These cases were referred after failure of medical and conservative treatment. Age, sex, clinical manifestation, and type of procedure were recorded. Analysis was done using SPSS version 11.0 (SPSS Inc, Chicago, IL, USA). The χ(2) test was used for comparison. Seventy-one cases were included in this study. Of these cases, 50 (70.4%) were male and 21 (29.6%) were female (p &amp;lt; 0.0001). Mean age of cases was 4.97 ±3.42 years (range: 2 days to 13 years). Of the male cases, 38% were in the age range of 3-6 years. In female cases, 57.1% were in the range of 1.5-3 years. Of all 71 cases, injection sclerotherapy was done for 50 (70.43%) for the first time. Twenty-one cases had history of injection sclerotherapy and 16 (22.53%) were treated by perineal surgery, and 5 (7.04%) had abdominal surgery. One case experienced recurrent rectal prolapse (1.40%) following injection sclerotherapy. In girls, more than half of the cases were in the age range 1.5-3 years. Among male cases, 38% were in the age range of 1.5-3 years. The results of treatment of rectal prolapse in our hospitals was similar to that seen in developed countries.