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Management of Complete Persistent Rectal Prolapse in Children: A Comparative Study Between Mesh Repair Versus
Mostafa Gad1, Mostafa Nabil Dessouky1, Khaled Salah Abdullateef1
1Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt.
Insights
Laparoscopic rectopexy is an effective treatment for persistent rectal prolapse in children. Both mesh and suture techniques showed similar positive outcomes, though further research is needed for deeper comparison.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Rectal prolapse is common in children aged 1-3 years, often resolving without surgery.
- Surgical intervention is reserved for persistent, intractable cases or those with complications like pain, bleeding, or difficult reduction.
Purpose of the Study:
- To compare the efficacy and outcomes of laparoscopic ventral mesh rectopexy versus laparoscopic suture rectopexy.
- To evaluate these surgical techniques in children with persistent rectal prolapse unresponsive to conservative management or prior treatments.
Main Methods:
- A randomized controlled trial involving 24 children with complete rectal prolapse.
- Patients were divided into two groups: laparoscopic ventral mesh rectopexy (Group 1) and laparoscopic suture rectopexy (Group 2).
- Exclusion criteria included anorectal malformations, Hirschsprung's disease, rectal polyps, and Ectopia Vesicae.
Main Results:
- One case in the mesh group experienced partial prolapse recurrence, resolving with conservative management.
- Minor postoperative complications (bleeding, vomiting) occurred in both groups, managed medically.
- No cases of complete rectal prolapse recurrence were reported in either group.
Conclusions:
- Laparoscopic rectopexy is an effective, safe, and straightforward treatment for refractory complete rectal prolapse in children.
- Laparoscopic suture rectopexy and mesh rectopexy demonstrated comparable results in this study.
- Larger studies are recommended to further compare the two laparoscopic rectopexy techniques.
Background:
Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The primary treatment of rectal prolapse is non-operative. Surgical intervention is needed in long-standing intractable cases of rectal prolapse, rectal pain/bleeding/ulceration and prolapse that needs frequent manual or difficult reduction. The aim of this study was to compare the efficacy and outcome of laparoscopic ventral mesh rectopexy versus laparoscopic suture rectopexy in the management of persistent rectal prolapse in children not responding to conservative management and/or recurrent after sclerotherapy or anal encirclement.
Materials And Methods:
Twenty-four cases were randomised into two groups at the ratio of 1:1, Group 1 patients were managed by laparoscopic ventral mesh rectopexy, whereas Group 2 cases were managed by laparoscopic suture rectopexy. Patients with primary surgical conditions such as anorectal malformations, Hirschsprung's disease, rectal polyps or masses and Ectopia Vesicae were excluded from the study. Inclusion criteria were complete rectal prolapse cases with failed medical treatment for at least 6 months and/or recurrent after injection sclerotherapy or anal encirclement.
Results:
In the mesh rectopexy group, one case had recurrence in the form of partial prolapse 3 weeks postoperatively which improved 2 months postoperatively with conservative management, one case had bleeding per rectum 2 months postoperatively, stool analysis was done revealing parasitic infestation which was treated medically. In the suture rectopexy group, one case had one attack of bleeding per rectum on the 2nd day postoperatively which resolved spontaneously and one case was readmitted on the 5th day postoperatively for non-bilious vomiting which improved by medical treatment. No recurrent cases of complete rectal prolapse were reported in both groups.
Conclusion:
Laparoscopic rectopexy can be an effective modality for the treatment of refractory complete rectal prolapse in children. It is effective, safe and easy. Although the current study has shown that laparoscopic suture rectopexy and mesh rectopexy have nearly the same results, a larger number of patients are needed to compare more deeply between the two groups.
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