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Sequential linear stapling technique for perineal resection of intractable pediatric rectal prolapse
Jong In Lee1, Adam M Vogel, Adam M Suchar
1Department of General Surgery, Kwandong University, Myongji Hospital, College of Medicine, Deokyang-Gu, Goyang, Gyeonggi, Korea.
Insights
Pediatric rectal prolapse (RP) can be challenging, especially in premature infants. A modified Altemeier technique using sequential linear stapling offers a safe and effective surgical option for intractable cases.
Area of Science:
- Pediatric surgery
- Gastroenterology
Background:
- Rectal prolapse (RP) is uncommon in children, posing significant challenges in premature infants with comorbidities.
- Conservative management is typically effective, but intractable cases require surgical intervention.
Observation:
- A novel sequential linear stapling technique was used to modify the Altemeier procedure for intractable pediatric RP.
- The procedure was performed on a 5.0-kg infant with severe comorbidities.
Findings:
- The infant experienced bowel movement resumption on postoperative Day 1.
- No recurrence of rectal prolapse was observed post-surgery.
Implications:
- This modified Altemeier technique with sequential linear stapling appears to be a safe and effective alternative for intractable pediatric rectal prolapse.
- Further studies may validate this approach for complex pediatric surgical cases.
Abstract:
Rectal prolapse (RP), although most frequently encountered in the frail elderly, may also occur in children. This condition is most troublesome in the premature infant with significant associated comorbidities. Pediatric RP most often can be managed conservatively with expectant and/or judicious use of laxative-based bowel regimens. In rare instances of intractable RP, surgical intervention ranging from simple (sclerotherapy, Thiersch wire) to complex (perineal or transabdominal bowel resection) becomes necessary. We describe a modification of the Altemeier technique using a novel sequential linear stapling technique to treat intractable RP in a 5.0-kg infant with severe coexisting life-threatening comorbidities. The child had resumption of bowel movements on postoperative Day 1 and has had no recurrences. Sequential linear stapling technique for perineal resection of intractable pediatric RP appears to be a safe and potentially attractive alternative.
