Pediatric Rectal Prolapse

Rentea, Rebecca M.; Peter, Shawn D. St.

doi:10.1055/s-0037-1609025

Cited by 38 publications

(32 citation statements)

References 76 publications

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“…These factors include a relatively weak pelvic floor, a straighter rectum and sacrum, and a lack of Houston's valves. 4,5,11,12 Though the exact age at which these predisposing factors resolve is unknown, the clinical impact of these factors is implied in the bias toward treating children >4 years old with rectal prolapse more like their adult counterparts. 6,12 There are many possible underlying causes for the alterations in motility that may lead to rectal prolapse (►Table 1).…”

Section: Etiology and Pathophysiologymentioning

confidence: 99%

“…23 It appears that older children thus tend to have an overall worse prognosis than younger children. 5 This may be a result of the underlying pathophysiology of rectal prolapse in the older population, or it may simply be a bias related to the fact that the milder cases of prolapse tend to resolve in early childhood, whereas the more medically refractory cases persist beyond the toddler years. Older children are also more likely to have underlying factors that predispose them to worse outcomes, such as persistent straining related to underlying developmental delay or behavioral issues, or previous surgery for an anorectal malformation or Hirschsprung's disease, and are more likely to undergo multiple surgical interventions.…”

Section: Clinical Presentation and Workupmentioning

confidence: 99%

“…3,4 This rate may vary worldwide according to the prevalence of underlying conditions other than idiopathic constipation such as acute diarrheal illness and malnutrition. 5 The high rate of spontaneous resolution differentiates pediatric rectal prolapse from adult prolapse where resolu-tion is unexpected without intervention. [6][7][8] The difference is especially true in children less than 4 years of age who are otherwise healthy.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Management of Rectal Prolapse in Infants and Children

2020

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The surgical management of children with rectal prolapse is wide ranging and without consensus within the pediatric surgical community. While the majority of rectal prolapse in infants and children resolves spontaneously or with the medical management of constipation, a small but significant subset of patients may require intervention for persistent symptoms. In this review, we discuss the etiology and pathophysiology of rectal prolapse in both infants and children, options for medical management, described interventions and surgical options and their outcomes, and future avenues for research and investigation.

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Section: Etiology and Pathophysiologymentioning

confidence: 99%

Section: Clinical Presentation and Workupmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Management of Rectal Prolapse in Infants and Children

2020

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“…Surgical therapy aims to prevent the prolapse by surgical fixation of the rectum. Multiple operative and procedural approaches to rectal prolapse exist with variable recurrence rates and without a clearly superior operation (Rentea and St Peter 2018). These include sclerotherapy, Thiersch's anal cerclage, Ekehorn's rectoplasty, laparoscopic suture rectoplasty, and posterior sagittal rectoplasty.…”

Section: Rectal Prolapsementioning

confidence: 99%

Disorders of Anus and Rectum

Pakarinen¹,

Rintala²,

Koivusalo³

2020

Pediatric Surgery

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Pediatric anorectal disorders include a variety of relatively common functional and anatomical defects. Around 10% of children are brought to medical attention because of an anorectal disorder. Besides constipation, other typical complaints include blood in the stool, pain, and specific local anal findings. It is essential that pediatric surgeons are familiar with the pathophysiology and management of these diverse and usually relatively benign conditions, as these problems are not uncommon and are regularly seen in emergency room and outpatient clinics.

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“…It is primarily treated nonoperatively with a high-fiber diet, stool softeners, laxatives, and avoidance of prolonged straining, with a success rate of 28%-50%. [1][2][3][4] Patients who fail conservative management may require surgical treatment to control the recurrent or persistent RP.…”

Section: Introductionmentioning

confidence: 99%

Same-Day Discharge and Quality of Life for Primary Laparoscopic Rectopexy for Rectal Prolapse in Children: A 10-Year Experience

Osuchukwu

Dorman

Dekonenko

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.

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Pediatric Rectal Prolapse

Cited by 38 publications

References 76 publications

Surgical Management of Rectal Prolapse in Infants and Children

Surgical Management of Rectal Prolapse in Infants and Children

Disorders of Anus and Rectum

Same-Day Discharge and Quality of Life for Primary Laparoscopic Rectopexy for Rectal Prolapse in Children: A 10-Year Experience

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