Advertisement

Pediatric Surgery International

, Volume 26, Issue 8, pp 807–813 | Cite as

Laparoscopic mesh rectopexy for complete rectal prolapse in children: a new simplified technique

  • Rafik Shalaby
  • Maged Ismail
  • Mohamad Abdelaziz
  • Refaat Ibrahem
  • Khaled Hefny
  • Abdelaziz Yehya
  • Abdelghany Essa
Original Article

Abstract

Purpose

Rectal prolapse in children without underlying conditions is usually a self-limiting problem and requires no surgical treatment. For children with persistent rectal prolapse, a variety of surgical procedures have been described with success. Recently, there are many reports addressing the successful use of different laparoscopic approaches for complete rectal prolapse. We present a novel simplified laparoscopic technique for management of those patients. The aim of this study is to evaluate the results that can be achieved by using this technique in management of persistent complete rectal prolapse in children.

Methods

We reviewed the reports of 680 patients with primary complete and partial rectal prolapse over the period from August 2000 to August 2008. Fifty-two patients with complete primary rectal prolapse refractory to medical treatment for 2 years underwent a novel simplified technique for laparoscopic mesh rectopexy.

Results

Conservative management was successful with no recurrences in 628 patients (92.4%) while 52 (7.6%) patients did not respond to conservative management at a median follow-up period of 2 years. They were 35 males and 17 females. Their ages ranged from 2 to 14 years (mean 6). All patients were subjected to laparoscopic mesh rectopexy successfully without any conversion. The mean duration of surgery was 40 min. No intraoperative complications were reported, but one patient developed postoperative constipation that responded well to conservative treatment. The mean postoperative hospitalization was 2 days. Two cases were lost to follow-up, while the others were available for 36 months. There was no recurrence.

Conclusion

Laparoscopy mesh rectopexy is safe, rapid, effective technique. It improved functional outcome without recurrence. It is associated with minimal postoperative pain and short hospital stay with excellent cosmoses.

Keywords

Laparoscopy Rectal prolapse Mesh rectopexy Rectosigmoid redundancy 

References

  1. 1.
    Lockhart-Mummery JP (1939) Surgical procedures in general practice. Br Med J 1:345–347CrossRefGoogle Scholar
  2. 2.
    Rintala RJ, Pakarinen M (2006) Other disorders of the anus and rectum, anorectal function. In: O’Neill J, Rowe M, Grosfeld J, Fonkalsrud E, Coran A (eds) Pediatric surgery, chap 102, 6th edn. Mosby, St Louis, pp 1595–1596Google Scholar
  3. 3.
    Shah A, Parikh D, Jawaheer G et al (2005) Persistent rectal prolapse in children: sclerotherapy and surgical management. Pediatr Surg Int 21(4):270–273CrossRefPubMedGoogle Scholar
  4. 4.
    Senagore AJ (2003) Management of rectal prolapse: the role of laparoscopic approaches. Semin Laparosc Surg 10(4):197–202PubMedGoogle Scholar
  5. 5.
    Sander S, Vural O, Unal M (1999) Management of rectal prolapse in children. Ekehorn’s rectosacropexy. Pediatr Surg Inter 15:111CrossRefGoogle Scholar
  6. 6.
    Benoist S, Taffinder N, Gould S, Chang A, Darzi A (2001) Functional results two years after laparoscopic rectopexy. Am J Surg 182(2):168–173CrossRefPubMedGoogle Scholar
  7. 7.
    Gourgiotis S, Baratsis S (2007) Rectal prolapse. Int J Colorectal Dis 22(3):231–243CrossRefPubMedGoogle Scholar
  8. 8.
    Theuerkauf FJ Jr, Beahrs OH, Hill JR (1970) Rectal prolapse: causation and surgical treatment. Ann Surg 171(6):819–835CrossRefPubMedGoogle Scholar
  9. 9.
    Koivusalo A, Pakarinen M, Rintala R (2006) Laparoscopic suture rectopexy in the treatment of persisting rectal prolapse in children: a preliminary report. Surg Endosc 20(6):960–963CrossRefPubMedGoogle Scholar
  10. 10.
    Heah SM, Hartley JE, Hurley J et al (2000) Laparoscopic suture rectopexy without resection is effective treatment for full thickness rectal prolapse. Dis Colon Rectum 43(5):638–643CrossRefPubMedGoogle Scholar
  11. 11.
    Lechaux D, Trebuchet G, Siproudhis L et al (2005) Laparoscopic rectopexy for full thickness rectal prolapse: a single-institution retrospective study evaluating surgical outcome. Surg Endosc 19(4):514–518 (Epub 2005 Mar 11)CrossRefPubMedGoogle Scholar
  12. 12.
    Boccasanta P, Rosati R, Venturi M et al (1998) Comparison of laparoscopic rectopexy with opens technique in the treatment of complete rectal prolapse: clinical and functional results. Surg Laparosc Endosc 8(6):460–465CrossRefPubMedGoogle Scholar
  13. 13.
    Ashcraft KW, Garred JL, Holder TM, Amoury RA, Sharp RJ, Murphy JP (1990) Rectal prolapse: 17-year experience with the posterior repair and suspension. J Pediatr Surg 25:992–995CrossRefPubMedGoogle Scholar
  14. 14.
    Chwals WJ, Brennan LP, Weinzmann JJ et al (1990) Transanal mucosal sleeve resection for the treatment of rectal prolapse in children. J Pediatr Surg 25:715–718CrossRefPubMedGoogle Scholar
  15. 15.
    Fahmy MA, Ezzelarab S (2004) Outcome of submucosal injection of different sclerosing materials for rectalprolapse in children. Pediatr Surg Int 20:353–356PubMedGoogle Scholar
  16. 16.
    Nelson R, Spitz J, Pearl RK et al (2001) What role does full rectal mobilization alone play in the treatment of rectal prolapse? Tech Coloproctol 5(1):33–35CrossRefPubMedGoogle Scholar
  17. 17.
    Bonnard A, Mougenot JP, Ferkdadji L, Huot O, Aigrain Y, De Lagausie P (2003) Laparoscopic rectopexy for solitary ulcer of rectum syndrome in a child. Surg Endosc 17:1156–1157CrossRefPubMedGoogle Scholar
  18. 18.
    Saxena AK, Metzelder ML, Willital GH (2004) Laparoscopic suture rectopexy for rectal prolapse in a 22-month-old child. Surg Laparosc Endosc Percutan Tech 14:33–34CrossRefPubMedGoogle Scholar
  19. 19.
    Okuyama H, Yagi M, Ikegami R et al (2002) Laparoscopic rectopexy for rectal prolapse in children. Pediatr Endosurg Innov Tech 6(4):285–288CrossRefGoogle Scholar
  20. 20.
    Auguste T, Dubreuil A, Bost R et al (2006) Technical and functional results after laparoscopic rectopexy to the promontory for complete rectal prolapse. Prospective study in 54 consecutive patients. Gastroenterol Clin Biol 30(5):659–663CrossRefPubMedGoogle Scholar
  21. 21.
    Antao B, Bradley V, Roberts JP, Shawis R (2005) Management of rectal prolapse in children. Dis Colon Rectum 48(8):1620–1625CrossRefPubMedGoogle Scholar
  22. 22.
    Hernández P, Targarona EM, Balagué C et al (2008) Laparoscopic treatment of rectal prolapse. Cir Esp 84(6):318–322 (article in Spanish)CrossRefPubMedGoogle Scholar
  23. 23.
    Hsu A, Brand MI, Saclarides TJ (2007) Laparoscopic rectopexy without resection: a worthwhile treatment for rectal prolapse in patients without prior constipation. Am Surg 73(9):858–861PubMedGoogle Scholar
  24. 24.
    Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73CrossRefPubMedGoogle Scholar
  25. 25.
    Kariv Y, Delaney Cp, Casillas S et al (2005) Long-Term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study. Pelvic Floor Digest 2005: Pelvic. Prolapse; Surg Endosc. 21Google Scholar
  26. 26.
    Demirbas S, Ml Akin, Kalemoglu M et al (2005) Comparison of laparoscopic and surgery for total rectal prolapse. Surg Today 35(6):446–452CrossRefPubMedGoogle Scholar
  27. 27.
    Von Papen M, Ashari LH, Lumley JW et al (2007) Functional results of laparoscopic resection rectopexy for symptomatic rectal intussusception. Dis Colon Rectum 50(1):50–55CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Rafik Shalaby
    • 1
    • 2
  • Maged Ismail
    • 1
  • Mohamad Abdelaziz
    • 1
  • Refaat Ibrahem
    • 1
  • Khaled Hefny
    • 1
  • Abdelaziz Yehya
    • 1
  • Abdelghany Essa
    • 1
  1. 1.Pediatric Surgery Unit, General Surgery DepartmentAl-Azhar UniversityCairoEgypt
  2. 2.Al-Hussain University HospitalCairoEgypt

Personalised recommendations