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Medhat M Ibrahim et al 10.5005/jp-journals-10033-1223
SurgicaL technique

Laparoscopic Rectopexy: is it Useful for Persistent

Rectal Prolapse in Children?

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1 Medhat M ibrahim, Mohammed Abd El Razik, Ahmed M Abdelkader
2
ABSTRACT full-thickness prolapse and incomplete or partial thickness
Rectal prolapse is a relatively common, usually self-limiting prolapse. Complete prolapse represents a protrusion of the
illness in children. Peak incidence is between 1 and 3 years. The entire layer of the rectum to the outside of the anus and, thus,
intervention is required for the persistent rectal prolapse (PRP). shows concentric folds. Incomplete prolapse is defined as a
Only scanty experience is available with laparoscopic rectopexy
in children. There is available work using both mesh and suture condition in which the protruding rectal wall is limited to the
laparoscopic rectopexy in literature. This work is unique in that inside of the anal canal, which is also referred to as occult
it presents our clinical experience with both mesh and suture
laparoscopic rectopexy in children. rectal prolapse or internal rectal intussusception. In clinical
This is a prospective clinical study for the outcome of lapa- practice, mucosal prolapse is readily confused with rectal
roscopic rectopexy (LRP) by both mesh and suture technique prolapse. Mucosal prolapse is not a protrusion of the whole
in children with persistent rectal prolapse.
layer of the rectal wall, but a portion of the rectal wall or
Materials and methods: fourteen cases of PRP were managed only the anal mucosa. It should be differentiated from rectal
with LRP from february 2008 to August 2012.
prolapse as the surgical treatments are different.
Results: Of the 14 children, 10 (71.42%) were males and
4 (28.57%) were females. Male to female ratio was 2:1. The Rectal prolapse in children is a relatively common,
mean age of presentation was 5 years (3-8 years). The presen- usually self-limiting illness in children. Peak incidence is
ting complaints were mass descending per rectum along with between 1 and 4 years. The intervention is required for
1,2
bleeding per rectum lasting from 1 to 3 years. All had rectal
prolapse of 5 to 7 cm in length. Twelve out of 14 children had the persistent rectal prolapse (PRP). Laparoscopic rectopexy
recurrence even after sclera-therapy before referral to laparo - (LRP) is in vogue for adults; however, only scanty expe-
scopic rectopexy. The mean duration of surgery was 30 minutes rience is available with this technique in children. We present
(20-60 minutes). No intraoperative complications were reported,
only one case get constipation and managed conservatively our experience with laparoscopic rectopexy for persistent
and no recurrence. rectal prolapse at the pediatric surgery unite.
Conclusion: LRP is safe, feasible in children and gives satisfac-
tory results after failure of all conservative even sclera-therapy MATERiALS And METhodS
injection.
Keywords: Laparoscopy, Rectopexy, Rectal prolapse. This is a prospective clinical study of 14 children managed
How to cite this article: Ibrahim MM, Razik MAE, Abdelkader with LRP (mesh and suture techniques) for PRP from April
AM. Laparoscopic Rectopexy: Is It Useful for Persistent Rectal 2008 to September 2012. The conservative management of
Prolapse in Children? World J Lap Surg 2014;7(2):92-96. nutritional support, bowel habit regulation, and dietary mani-
Source of support: Nil pulation for managing the prolapse had failed in all cases
Conflict of interest: None and were referred for surgical intervention. Twelve of
the 14 patients were managed with sclerotherapy using
inTRodUCTion ethanolamine oleate injected submucosally in three to four

Rectal prolapse describes a condition in which the entire sittings before being referred to laparoscope rectopexy. Cases
layer of the rectal wall protrudes through the anal canal. with rectal prolapse who did not respond to conservative
Rectal prolapse is classified into two types: complete or management over 2 years were defined as PRP and were
subjected to LRP. The decision to operate was based on the
age of patient, duration of conservative management was
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1,2 Assistant Professor, Registrar more than 18 months, and frequency prolapse was more than
1,2 Pediatric Surgery Unit, faculty of Medicine, Al-Azhar two episodes requiring manual reduction per month, rectal
University, Nasr City, Cairo, Egypt bleeding, edema, ulceration, difficult reduction. The age,
3 General Surgery Unit, Royal Commission Medical Center sex, weight, and initial presentation, duration of symptoms,
Yanbu Industrial City, Saudi Arabia precipitating events and comorbidities were maintained.

Corresponding Author: Medhat M Ibrahim, Assistant Professor Preoperative evaluation included history and physical exa mi -
Pediatric Surgery Unit, faculty of Medicine, Al-Azhar Univer sity nation, routine laboratory investigation, MRI pelvic floor
Nasr City, Cairo, Egypt, e-mail: dr_medhat_ibrahem@yahoo.com
muscle and spinal bone and lateral view, defecography,
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