Same-Day Discharge and Quality of Life for Primary Laparoscopic Rectopexy for Rectal Prolapse in Children: A 10-Year Experience
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Published on: October 25, 2024
Obiyo Osuchukwu1, Robert M Dorman1, Charlene Dekonenko1
1Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, Missouri, USA.
Insights
Laparoscopic rectopexy offers a safe, minimally invasive surgical option for pediatric idiopathic rectal prolapse (RP). This approach demonstrates high patient satisfaction, early recovery, and a low recurrence rate, making it an effective treatment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Rectal prolapse (RP) in children often necessitates surgical intervention.
- Varied surgical techniques and patient populations complicate outcome assessment.
- Laparoscopic rectopexy is an option for idiopathic RP.
Purpose of the Study:
- To review surgical and self-reported outcomes of pediatric patients undergoing laparoscopic rectopexy for idiopathic rectal prolapse.
- To evaluate the safety and efficacy of this minimally invasive approach.
Main Methods:
- Retrospective review of pediatric patients (<18 years) undergoing primary laparoscopic rectopexy (March 2009-March 2019).
- Exclusion of redo rectopexy cases.
- Collection of demographic, perioperative, and outcome data; qualitative analysis of postoperative quality of life questionnaires.
Main Results:
- Fifteen patients included (median age 5 years, 60% male).
- High rate of same-day discharge (60%) and reduced laxative use post-surgery.
- Low recurrence rate (20%), with improvement in self-reported quality of life and no fecal incontinence.
Conclusions:
- Laparoscopic rectopexy is a safe and effective minimally invasive treatment for pediatric idiopathic rectal prolapse.
- The procedure is associated with high patient satisfaction, rapid recovery, and favorable long-term outcomes.
Abstract:
Rectal prolapse (RP) in pediatric patients may require surgical intervention. Varying surgical approaches and heterogenous patient populations have resulted in difficulty defining surgical outcomes and superiority of technique. We sought to review our surgical and self-reported outcomes of patients who underwent laparoscopic rectopexy for idiopathic RP. Records of children <18 years who underwent primary laparoscopic rectopexy between March 2009 and March 2019 were retrospectively reviewed. Patients with redo rectopexy were excluded. Demographics, pre- and postoperative treatment, and outcome data were collected and reported using descriptive statistics. Qualitative analysis of a quality of life (QoL) questionnaire administered to patients and parents 2-10 years postoperatively was performed. Fifteen patients were included. Median age at surgery was 5 years (interquartile range [IQR] 3, 12.5); 60% were male and median weight was 22 kg (IQR 16.4, 39.2). Median length of stay was 6 hours (IQR 4, 22) with 9 (60%) discharged the same day. Perioperatively, 73% were on laxative for constipation, whereas only 33% were on laxative therapy at 6 months postrectopexy. Median follow-up was 19 months (IQR 8, 39). Three patients (20%) suffered recurrent RP (2 required redo rectopexy), and 2 patients self-limited urinary retention. Respondents to the QoL questionnaire indicated improvement in symptoms after surgery. No patient reported fecal incontinence, smearing, or leakage of stool. Laparoscopic rectopexy is a safe minimally invasive approach for children with idiopathic RP that offers high patient satisfaction with same-day discharge, early recovery, and low recurrence.
