Abstract

Objective: Rectal prolapse is common in children below the age of 4 years. A significant number of children undergo spontaneous resolution over time, hence upfront surgical treatment is not commonly offered to these patients, resulting in prolonged sufferring in symptomatic children while hoping for a spontaneous resolution. Abdominal rectopexy involves extensive mobilization of the rectum followed by its fixation to the presacral fascia(1) thereby increasing the risk of damage to the nervi erigentes, with resultant postoperative constipation, bladder and sexual dysfunction. The present study was done on the premise that the pathophysiology of prolapse begins with intussusception and hence can be prevented by pexing the start point that is the rectosigmoid instead of the rectum.

Methods: Our study included patients over a period of six years who underwent upfront surgery for full thickness rectal prolapse. The surgery performed was a modification of the Well’s procedure, by avoiding rectal mobilisation completely and by fixing the rectosigmoid to the presacral fascia using an absorbable mesh.

Results: 17 patients (mean age - 7 years) underwent surgery. Early recurrence occurred in one patient. There was no prolonged constipation, bladder dysfunction or mesh related complications.

Conclusion: Upfront surgery for complete rectal prolapse stops the suffering a child has to undergo each time the child passes stools, while the parents are hoping for a spontaneous resolution with some form of conservative management. The surgical technique we followed is effective and avoids complications arising due to denervation of the rectum during mobilization.

Cite as: Patcharu R, Chand K, Dey S, Chandra N. Pediatric rectal prolapse. Why let them suffer? Coc Cer Derg/Turkish J Ped Surg. 2022; 36(1): 43-49. doi: 10.29228/JTAPS.53850