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Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse
Published on: September 13, 2022
Perineal mesh rectopexy with sterile talc in children with rectal prolapse
M Nazem1, M Hosseinpour, M Farhadi
1Al-Zahra Hospital, Department of Pediatric Surgery, Isfahan, Islamic Republic of Iran.
Insights
Perineal mesh rectopexy using sterile talc in children offers comparable outcomes to abdominal surgery with a significantly higher resolution of constipation and a low complication rate.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Optimal treatment for pediatric rectal prolapse remains debated due to varied success rates of existing options.
- This study investigates perineal mesh rectopexy with sterile talc-soaked mesh as an alternative to abdominal rectopexy.
- Evaluating success rates and complications is crucial for determining the best surgical approach.
Purpose of the Study:
- To compare the efficacy and safety of perineal mesh rectopexy with abdominal rectopexy in treating pediatric rectal prolapse.
- To assess outcomes including complication rates, constipation resolution, and hospitalization duration.
- To determine if perineal mesh rectopexy is a viable alternative surgical option.
Main Methods:
- A randomized control trial involving 120 children with rectal prolapse.
- Children were randomized into two groups: abdominal posterior mesh rectopexy (control) and perineal mesh rectopexy with a gradually removed talc-soaked mesh (case).
- Outcomes measured included postoperative complications, infection rates, constipation resolution, and duration of hospitalization, with a one-year follow-up.
Main Results:
- No statistically significant difference in overall postoperative complications or infection rates between the two groups.
- A significantly higher resolution of constipation was observed in the perineal rectopexy group (96.8%) compared to the abdominal group (68.4%).
- Hospitalization duration was comparable between the perineal and abdominal rectopexy groups.
Conclusions:
- Perineal mesh rectopexy with sterile talc demonstrates an acceptable outcome and a low complication rate in pediatric patients.
- This technique presents a promising alternative to traditional abdominal surgery for rectal prolapse in children.
- The improved resolution of constipation highlights a key benefit of the perineal approach.
Background:
With such a wide variety of treatment options available for rectal prolapse and a variable success rate, the optimal treatment for this condition in children is still debated. In this study, we evaluated a technique of perineal mesh rectopexy with a sterile talc-soaked mesh and compared the success rates and complications of this method with those of abdominal rectopexy.
Methods And Materials:
To examine the effect of therapeutic interventions, a randomized control trial (children were randomized into the case group or the control group) was carried out. In the control group, children were operated on by abdominal posterior mesh rectopexy. In the case group, a 30-cm sterile asbestos-free talc-soaked mesh was placed in the presacral space in a spiral fashion with the end exiting from the perineal incision. From 5 (th) day after surgery onward, the mesh was gradually extracted (10 cm per day) and completely removed by the 7 (th) postoperative day. On postoperative assessment, the duration of hospitalization, the postoperative complications and the success rates after surgery were compared. Patients were followed up for one year.
Results:
In this study we evaluated 120 children. Mean age of the patients was 5.1±0.081 years in the case group and 4.91±0.59 years in the control group (p=NS). 34 patients in the case group were male vs. 41 patients in the control group. Results indicated that there was no statistically significant difference in postoperative complications between groups. The infection rate was 1.6% in the case group and 6.6% in the control group (p=NS).There was a higher resolution of constipation in the perineal rectopexy group (68.4% in the control group and 96.8% in the case group; p=0.002). The duration of hospitalization was 6.34±0.28 days in the case group and 6.68±0.31 days in the control group (p=NS).
Conclusion:
Our findings suggest that perineal mesh rectopexy with sterile talc can be an alternative approach to abdominal surgery and offers an acceptable outcome with a low rate of complications.
