Laparoscopic Rectopexy; Is It Useful for Persistent Rectal Prolapse in Children?

Medhat M. Ibrahim, Mohammed Abd El Razik, Ahmed M. Abdelkader

General Surgery Unite RCMC, Yanbu Industrial City, KSA.
Pediatric Surgery Unit, Faculty of Medicine, Al-Azhar University, Nasr City, Cairo, Egypt.

DOI: 10.4236/ss.2014.53023                

Abstract

Introduction: Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The intervention is required for the persistent rectal prolapse (PRP). Only scanty experience is available with laparoscopic rectopexy in children. There is no available work using both mesh and suture laparoscopic rectopexy in literature. This work is unique that it presents our clinical experience with both mesh and suture laparoscopic rectopexy in children. This is a prospective clinical study for the outcome of laparoscopic rectopexy (LRP) by both mesh and suture technique in children with persistent rectal prolapse (PRP). Materials and Methods: Fourteen cases of PRP were managed with LRP from February 2008 to August 2012. Results: Of the 14 children, 10 (71.42%) were males and 4 (28.57%) were females. Male to female ratio was 2:1. The mean age of presentation was 5 years (range 3 - 8 years). The presenting complaints were mass descending per rectum along with bleeding per rectum lasting from 1 to 3 years. All had rectal prolapse of 5 - 7 cm in length. 12 out of 14 children had recurrence even after sclerotherapy before referral to laparoscopic rectpexy. The mean duration of surgery was 30 minutes (range 20 - 60 minutes). No intraoperative complications were reported; only one case got constipation and was managed conservatively and no recurrence. Conclusion: LRP is safe, feasible in children and gives satisfactory results after failure of all conservative even sclerotherapy injection.

Keywords

Rectal Prolapse; Laparoscopy; Rectopexy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Siafakas, C., Vottler, T.P. and Andersen, J.M. (1999) Rectal Prolapse in Pediatrics. Clinical Pediatrics, 38, 63-72.
[2]	Qvist, N., Rasmussen, L., Klaaborg, K.E., Hansen, L.P. and Pedersen, S.A. (1986) Rectal Prolapse in Infancy: Conservative versus Operative Treatment. Journal of Pediatric Surgery, 21, 887-888. http://dx.doi.org/10.1016/S0022-3468(86)80015-X
[3]	Gourgiotis, S. and Baratsis, S. (2007) Rectal Prolapse. International Journal of Colorectal Disease, 22, 231-243. http://dx.doi.org/10.1007/s00384-006-0198-2
[4]	Theuerkauf Jr., F.J., Beahrs, O.H. and Hill, J.R. (1970) Rectal Prolapse: Causation and Surgical Treatment. Annals of Surgery, 171, 819-835. http://dx.doi.org/10.1097/00000658-197006010-00002
[5]	Corman, M.L. (1985) Rectal Prolapse in Children. Diseases of the Colon & Rectum, 28, 535-539. http://dx.doi.org/10.1007/BF02554107
[6]	Abes, M. and Sarihan, H. (2004) Injection Sclerotherapy of Rectal Prolapse in Children with 15 Percent Saline Solution. European Journal of Pediatric Surgery, 14, 100-102. http://dx.doi.org/10.1055/s-2004-815855
[7]	Madiba, T.E., Baig, M.K. and Wexner, S.D. (2005) Surgical Management of Rectal Prolapse. Archives of Surgery, 140, 63-73. http://dx.doi.org/10.1001/archsurg.140.1.63
[8]	Shalaby, R., Ismail, M., Abdelaziz, M., Ibrahem, R., Hefny, K., Yehya, A., et al. (2010) Laparoscopic Mesh Rectopexy for Complete Rectal Prolapsed in Children: A New Simplified Technique. Pediatric Surgery International, 26, 807-813. http://dx.doi.org/10.1007/s00383-010-2620-7
[9]	Koivusalo, A., Pakarinen, M. and Rintala, R. (2006) Laparoscopic Suture Rectopexy in the Treatment of Persisting Rectal Prolapse in Children: A Preliminary Report. Surgical Endoscopy, 20, 960-963. http://dx.doi.org/10.1007/s00464-005-0424-y
[10]	Safar, B. and Vernava, A.M. (2008) Abdominal Approaches for Rectal Prolapse. Clinics in Colon and Rectal Surgery, 21, 94-99.
[11]	Ashcraft, K.W., Garred, J.L., Holder, T.M., Amoury, R.A., Sharp, R.J. and Murphy, J.P. (1990) Rectal Prolapse: 17-Year Experience with the Posterior Repair and Suspension. Journal of Pediatric Surgery, 25, 992-995. http://dx.doi.org/10.1016/0022-3468(90)90245-5
[12]	Pearl, R.H., Ein, S.H. and Churchill, B. (1989) Posterior Sagittal Anorectoplasty for Pediatric Recurrent Rectal Prolapse. Journal of Pediatric Surgery, 24, 1100-1102. http://dx.doi.org/10.1016/S0022-3468 (89)80228-3
[13]	Tsugawa, C., Matsumoto, Y., Nishijima, E., Muraji, T. and Higashimoto, Y. (1995) Posterior Plication of the Rectum for Rectal Prolapse in Children. Journal of Pediatric Surgery, 30, 692-693. http://dx.doi.org/10.1016/0022-3468(95)90692-4
[14]	Wyatt, A.P. (1981) Perinealrectopexy for Rectal Prolapse. British Journal of Surgery, 68, 717-719. http://dx.doi.org/10.1002/bjs.1800681014
[15]	Chwals, W.J., Brennan, L.P., Weitzman, J.J. and Woolley, M.M. (1990) Transanal Mucosal Sleeve Resection for the Treatmentof Rectal Prolapse in Children. Journal of Pediatric Surgery, 25, 715-718. http://dx.doi.org/10.1016/S0022-3468(05)80003-X
[16]	Wyllie, G.G. (1979) The Injection Treatment of Rectal Prolapse. Journal of Pediatric Surgery, 14, 62-64. http://dx.doi.org/10.1016/S0022-3468(79)80578-3
[17]	Fahmy, M.A. and Ezzelarab, S. (2004) Outcome of Submucosal Injection of Different Sclerosing Materials for Rectal Prolapse in Children. Pediatric Surgery International, 20, 353-356.
[18]	Oeconomopoulos, C.T. and Swenson, O. (1960) Thiersch’s Operation for Rectal Prolapsed in Infants and Children. The American Journal of Surgery, 100, 457-461. http://dx.doi.org/10.1016/0002-9610 (60)90388-3
[19]	Purkayastha, S., Tekkis, P., Athanasiou, T., Aziz, O., Paraskevas, P., Ziprin, P., et al. (2005) A Comparison of Open vs Lap Abdominal Rectopexy for Full-Thickness Rectal Prolapse: A Meta-Analysis. Diseases of the Colon & Rectum, 48, 1930-1940. http://dx.doi.org/10.1007/s10350-005-0077-x
[20]	Saxena, A.K., Metzelder, M.L. and Willital, G.H. (2004) Laparoscopic Suture Rectopexy for Rectal Prolapse in a 22-Month-Old Child. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 14, 33-34. http://dx.doi.org/10.1097/00129689-200402000-00009
[21]	Bonnard, A., Mougenot, J.P., Ferkdadji, L., Huot, O., Aigrain, Y., De Lagausie, P., et al. (2003) Laparoscopic Rectopexy for Solitary Ulcer of Rectum Syndrome in a Child. Surgical Endoscopy, 17, 1156-1157. http://dx.doi.org/10.1007/s00464-002-4285-3