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Abdominal posterior rectopexy with an omental pedicle for intractable rectal prolapse: a modified technique
K Elmalik1, H Dagash, R N Shawis
1Paediatric Surgical Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK. khalidelmalik@yahoo.co.uk
Insights
This study introduces a novel abdominal posterior rectopexy using an omental pedicle for pediatric rectal prolapse. The technique showed promising results with no recurrence in a small patient cohort.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Rectal prolapse is a common pediatric surgical issue with various causes.
- Management typically involves bowel habit regulation, with surgery reserved for treatment failures.
- Existing surgical techniques for rectal prolapse have varied outcomes.
Purpose of the Study:
- To evaluate a novel abdominal posterior rectopexy technique using an omental pedicle in children with intractable rectal prolapse.
- To assess the safety and efficacy of this new surgical approach.
Main Methods:
- A limited abdominal approach was used to perform posterior rectopexy with an omental pedicle.
- The technique was applied to five pediatric patients with recurrent rectal prolapse unresponsive to other treatments.
- One patient with solitary rectal ulcer syndrome underwent concomitant sigmoidectomy.
Main Results:
- No operative complications were observed in the five patients.
- The mean hospital stay was 5.4 days.
- At a mean follow-up of 2.1 years, no patients experienced recurrence, and cosmetic results were satisfactory.
Conclusions:
- Abdominal posterior rectopexy with an omental pedicle is an encouraging technique for pediatric rectal prolapse.
- This method avoids synthetic materials, potentially lowering infection risk.
- The technique shows promise for managing intractable cases in children.
Introduction:
Rectal prolapse is a relatively common paediatric surgical condition. It has a number of benign aetiologies. Management is usually centred on regulating bowel habits. Surgery is considered after the failure of medical treatment. Numerous surgical techniques have been described with a spectrum of results.
Materials And Methods:
We adopted a limited abdominal approach to achieve a posterior rectopexy using an omental pedicle in intractable cases. This technique has not been performed in children previously.
Results:
From 2005 to 2008 we have applied this technique on five patients with recurrent rectal prolapse which had failed to respond to medical treatment, injection sclerotherapy or perianal cercalage. One patient had solitary rectal ulcer syndrome, and was initially treated with a defunctioning colostomy, had a concomitant sigmoidectomy performed at the time of rectopexy. None of the patients had cystic fibrosis. There were three females and two males, with a mean age of 9.6 years (4.7-14.0). No operative complications were encountered. The mean hospital stay was 5.4 days (3-8). None of the patients experienced recurrence at a mean of 2.1 years (0.2-2.8) follow up. The cosmetic result was regarded as satisfactory by all patients.
Conclusion:
This early experience with abdominal posterior rectopexy using an omental pedicle graft is encouraging. This technique does not involve the use of synthetic material and hence the risk of infection is low.
