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WJOLS

Laparoscopic Rectopexy: Is It Useful for Persistent Rectal Prolapse in Children?
requiring surgical intervention. The percentage of children incision. It has been reported that prosthetic materials are
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requiring surgical intervention, eventually, after failure of not necessary in all cases.
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conservative management varies from 14 to 20%. Surgery Shalaby et al, in their study, reported the mean dura-
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is indicated in rare cases with intractable rectal prolapse tion of surgery as 40 minutes (30-55 minutes). Rintala
and may be considered in patients who are not sponta- et al reported a median operation time of 80 minutes (62-
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neously cured in 12 months of follow-up. The mean period 90 minutes) for laparoscopic suture rectopexy and a median
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of conservative management in this study could actually hospital time of 6 days (3-8 days). The mean hospitalization
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be ascertained as this study was conducted at a tertiary time was 3 days. Experience with LRP in this study further
care hospital, whereas the patients were managed from the reinforces these findings; also continuous laparoscopic use
start. However, a trial of at least 24 months of conservative will improve the operative procedure, operative time, and
management was given before the patients were referred to make the hospital stay shorter. The mean duration of surgery
laparoscopic rectopexy. was 30 minutes (20-60 minutes). No intraoperative compli-
Literature is replete with several treatment modalities, cations were reported. Mean postoperative hospitalization
such as conservative treatment by regulation of toilet habit was 6 days (4-10 days).
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and modulation of diet, injection of sclerotherapy, 13-15 The recurrence rates reported for PRP are as much as
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linear cauterization, encircling the anus, 17,18 trans anal 6.9% at 5 years and 10.8% at 10 years. Recurrent cases can
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resection, abdominal rectopexy, posterior repair and sus- be treated by laparoscopic resection rectopexy with or with-
pension. 3,12 Each one of these techniques has its advantages out mesh. 15,24 Some investigators reported that laparoscopic
and limitations which is a testimony to the lack of consensus rectopexy with or without mesh is safe, rapid, and effective
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over an ideal procedure. The operative procedures can be and can improve functional outcome without recurrence.
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classified as abdominal or perineal. 3,12,21,22 the less inva- However, Rintala and Pakarinen prefer laparoscopic suspen-
sive procedure as injection sclerotherapy and encircling sion of the rectum to anterior sacrum without mesh and they
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the anus reported success rate of nearly 90% in different claimed that this approach is successful in several patients.
series. 9,15 In this study, the conservative procedure was tried. In this study, after a mean follow-up of 6 months, we had no
Injection scleratherapy and liner cauterization was triad also recurrence because the sutures will fixe the rectum strongly
before referral to laparoscopic rectopexy. This makes our in the sacral promontory that acted as a dock, while the mesh
procedure an effective valuable method for management is going to create a port for the rectum to seal over it.
of the persistent rectal prolapse in children with evident Shalaby et al reported only one case of postoperative
recurrence. constipation out of 52 cases operated with laparoscopic
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Pediatric surgeons gained good experience in laparos- mesh rectopexy. Rintala reported two patients with post-
copic approach and improved the surgical results. 5,23,24 operative constipation. They added that constipation is the
Laparoscopic surgery has the advantages of good accessibi- only postoperative problem and is frequently worsened. In
lity, butter visualization of the narrow pelvic space anatomy this study, we had just one case of postoperative constipa-
during surgery, less postoperative pain, shorter hospital stay tion, managed conservatively in spite the longer use of the
and early recovery, as compared with laparotomy. Apart postoperative laxative and diet manipulation to prevent the
from these advantages, the results are similar to those with constipation. This stands in stark contrast to high rate (35%)
the open procedures irrespective of the method used (suture, of postoperative constipation reported earlier by Kariv
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resection or posterior mesh). We used the rational that was et al. All our 14 children were continent to solid with some
described by Ashcraft et al in 1990 as the ‘levator repair difficult control of gas and fluid at the time of presentation.
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and posterior suspension procedure’ for rectal prolapse. None of them had any incontinence issues in the postopera-
The technique surgically accomplishes the objectives of tive setting even the gas and fluid improved.
nonoperative and operative methods of treatment through Although this is a single center experience without a
minimal invasive procedure. Advanced laparoscopic tech- control group, the results are satisfactory. Whereas larger
niques in children need experience and require specific randomized control studies are required to secure conclu-
settings that may not be available in all centers but our sive evidence for the superiority of our procedure over the
technique is easy to be performed. conventional open procedure and also other laparoscopic
Both conventional and laparoscopic abdominal rectopexy technique, paucity of PRP cases in a single center remains
approaches still carries the risk of bladder dysfunction and the limiting factor. We conclude that LRP is an effective and
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impotence. This is not observed in our procedure due to safe minimal invasive procedure alternative to the open and
the minimal pelvic dissection. Laparoscopic mesh rectopexy laparoscopic procedures with similar success rates and no
could avoid the morbidity of a large perineal or abdominal additional complications.
World Journal of Laparoscopic Surgery, May-August 2014;7(2):92-96 95