Classification and management of rectal prolapse after anorectoplasty for anorectal malformations

Brisighelli, Giulia; Cesare, Antonio Di; Morandi, Anna; Paraboschi, Irene; Canazza, Lorena; Consonni, Dario; Leva, Ernesto

doi:10.1007/s00383-014-3533-7

Cited by 32 publications

(19 citation statements)

References 8 publications

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“…[4][5][6][7][8][9]22 The outcomes variably evaluated by the authors were: perioperative clinical results, rectal manometry, magnetic resonance imaging (MRI), length of stay, and complications. Ten articles described the radiographic features of the sacrum/spinal cord [7][8][9][10][11][23][24][25][26][27][28][29] and five reported a sacral ratio calculation. [7][8][9][10]27,28,30 Clinical results were reported in nine using various scoring systems.…”

Section: Resultsmentioning

confidence: 99%

“…51 Risk factors associated with prolapse noted in the literature review were tethered cord (40 vs. 24%), vertebral anomalies (39 vs. 24%), LAARP (75 vs. 25%), and when a colostomy was performed at the birth (49 vs. 9%). 23 To avoid rectal prolapse, a U-stitch has been described using a Vicryl suture applied to the presacral fascia to the rectal wall to tack the rectum in position. 25 This reduced prolapse rates significantly in a single-institution review compared with those patients who did not have the suture.…”

Section: Unique Complications With the Addition Of Laparoscopymentioning

confidence: 99%

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The Role of Laparoscopy in Anorectal Malformations

et al. 2020

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The use of laparoscopy in the minimally invasive management of anorectal malformations (ARMs) continues to evolve, although the principles guiding the anatomic surgical repair and clinical follow-up remain unchanged. In this review, we detail the advantages, indications, contraindications, complications, and issues unique to the minimally invasive approach to ARM. A comprehensive search of the PubMed and Embase databases was performed (2014–2018). Full-text screening, data abstraction, and quality appraisal were performed of articles describing the use of laparoscopy in ARM and cloaca. While new developments and approaches to ARM utilizing minimally invasive techniques and timing for surgical approach have been detailed, a unique complication profile involving greater risk of rectal prolapse and retention of a remnant of the original fistula are still consistently reported. Analysis of perioperative complications and long-term functional outcomes, including rates of fecal and urinary continence, are lacking. It is clear that patient selection for the choice of surgical approach based on precise preoperative delineation of the anatomy is the key. Adherence to the principles of ARM repair as well as application of operative/imaging adjuncts will yield the best technically safe minimally invasive approach to ARM. Continued efforts for standardized reporting and long-term follow-up are required.

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Section: Resultsmentioning

confidence: 99%

Section: Unique Complications With the Addition Of Laparoscopymentioning

confidence: 99%

The Role of Laparoscopy in Anorectal Malformations

et al. 2020

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“…), thus making it hard to draw a conclusion from this data but highlighting the importance of a prospective randomized trial to determine what modality of anal dilations can have a better impact on postoperative outcomes. 13,14 We are aware of the limitations of our study. It is a survey and it is therefore possibly influenced by the fact that there might have been a bias in selecting the participants, that some of the answering options might not have corresponded exactly to the practice of each participant, that different protocols may be adopted in the same center, and that comparing the outcomes between participants who belong to very different working realities is never advisable.…”

Section: Discussionmentioning

confidence: 95%

“…In keeping with what observed in the literature, the incidence of anal stenosis and rectal prolapse that required a reoperation was reported to be less than 5% by most participants. 13,14 However, being this a survey, and given the fact that there might be different attitudes toward the indications to operate anal stenosis and rectal prolapse, this finding has some limitations. Moreover, the answer provided could be just an approximation, as some centers might not have easy access to this information.…”

Section: Discussionmentioning

confidence: 99%

The Practice of Anal Dilations following Anorectal Reconstruction in Patients with Anorectal Malformations: An International Survey

et al. 2016

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The objective of this study was to investigate the current practices of anal dilations after anorectal reconstruction for anorectal malformations (ARMs) in different centers. An online survey, consisting of 27 questions about the practice of anal dilations, was launched in March 2015 among 54 pediatric surgeons with expertise in colorectal surgery. The survey was divided into three sections. The first section included questions regarding the country of origin, the role in the department, the average number of ARM cases treated per year, and the surgical approach used to repair ARMs. The second section was accessible only for surgeons who perform anal dilations and enquired about their modality of performing anal dilations-their attitude toward complications such as rectal prolapse, bleeding, or perineal dehiscence occurring during dilations-and about the incidence of rectal prolapse and/or anal stenosis, which required surgical repair, in their series of patients with ARMs. The third section was accessible only for surgeons who do not perform anal dilations and enquired the incidence of rectal prolapse and/or anal stenosis that required surgical repair in their series of patients with ARMs. A total of 36 pediatric surgeons from 20 countries completed the survey. All participants performed anal dilations. Twenty-five (70%) surgeons performed the first dilation 14 days after anorectal reconstruction; 30 (83%) surgeons performed it in the outpatient clinic; 34 (94%) surgeons used metal dilators and 30 (83%) surgeons lubricated the dilator with an anesthetic/steroid-free ointment; 21 (59%) surgeons tailored the first dilator size to the specific anatomical features of each patient; 27 (75%) surgeons used 1-mm-diameter increments in the dilator size and 22 (61%) surgeons increased the size weekly; 16 (45%) surgeons followed up with the patients weekly until the proper dilator size was reached. This was determined according to Peña's protocol by 25 (70%) surgeons: 23(64%) surgeons initially performed dilations twice daily; 24(66%) surgeons tapered the frequency of dilations once the desired caliber was reached. No general agreement exists in the management of complications such as rectal prolapse, bleeding, or perineal dehiscence occurring during dilations. Incidence of rectal prolapse and anal stenosis was reported less than 5%, respectively, by 25(70%) and 29(81%) respondents. Anal dilations for ARM are performed worldwide according to different modalities. Prospective and randomized clinical trials could be useful to establish a standardized protocol.

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“…Rectal prolapse (RP) can be classified into a pediatric type which usually presents with mucosal prolapse only and an adult type showing full-thickness protrusion [ 1 , 2 ]. It may be graded as minimal when the rectal mucosa is visible only with Valsalva maneuver, moderate when the prolapse is less than 5 mm without Valsalva maneuver and evident when the prolapse exceeds 5 mm without Valsalva maneuver [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic posterior rectopexy (Well’s procedure) for full-thickness rectal prolapse following laparoscopic repair of an anorectal malformation: A case report

Elhaddad

Amerstorfer

Singer

et al. 2018

International Journal of Surgery Case Reports

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HighlightsLaparoscopic repair of intermediate anorectal malformation (ARM) lead to full-thickness rectal prolapse (RP) in a boy.As conservative treatment modalities failed, the parents opted for surgical treatment at the patient’s age of 4 years.Intractable RP of 2 cm with ulcerations was successfully treated by Well’s laparoscopic posterior mesh-rectopexy.The mid-term outcome was favorable with no prolapse recurrence.Well’s procedure represents a feasible treatment option for RP secondary to ARM repair in children.

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Classification and management of rectal prolapse after anorectoplasty for anorectal malformations

Abstract: Severe ARMs, tethered cord, vertebral anomalies, colostomy, and LAARP predispose to rectal prolapse. Classifying prolapse allows to predict symptoms and need for surgical correction, and to compare outcomes among different centers.

Cited by 32 publications

References 8 publications

The Role of Laparoscopy in Anorectal Malformations

The Role of Laparoscopy in Anorectal Malformations

The Practice of Anal Dilations following Anorectal Reconstruction in Patients with Anorectal Malformations: An International Survey

Laparoscopic posterior rectopexy (Well’s procedure) for full-thickness rectal prolapse following laparoscopic repair of an anorectal malformation: A case report

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