Our Summary

Rectal prolapse, a condition where the rectum slips out of place, is fairly common in infants and young children. The best way to treat this condition after initial treatment, however, is not widely agreed upon. To try and find the best secondary treatment approach, researchers conducted a review of existing studies on the topic.

They looked at studies published from 1990 to 2017 that used the terms “rectal prolapse” and “children”, and found 27 studies that fit their strict criteria. They then analyzed these studies for information on the patients, the treatment used, how effective it was, and any complications.

They found that one method, injection sclerotherapy, had an initial success rate of almost 80%. This method involves injecting a substance into the body to shrink the prolapsed rectum. Ethyl alcohol was found to be the best substance to use due to its high success rate, low rate of complications, and easy availability.

There were also several types of surgical repairs found, with success rates ranging from around 61% to 100%. The most commonly reported surgical procedure was laparoscopic rectopexy with mesh, which had an overall success rate of over 96%. This procedure involves using a laparoscope (a long, thin tube with a high-intensity light and a high-resolution camera at the front) to put the rectum back in place and secure it with a mesh.

The researchers concluded that while there are many secondary treatment options for rectal prolapse in children, injection sclerotherapy and laparoscopic rectopexy are the most commonly reported in recent studies and seem to have high success rates and low rates of complications.

FAQs

  1. What are the current secondary treatment methods for rectal prolapse in children?
  2. What is the success rate of sclerotherapy and laparoscopic rectopexy in treating rectal prolapse in children?
  3. Are there any significant postoperative complications from rectal prolapse surgery in children?

Doctor’s Tip

A helpful tip a doctor might tell a patient about rectal prolapse surgery is to follow post-operative care instructions closely to ensure proper healing and to reduce the risk of complications. This may include taking pain medication as prescribed, avoiding heavy lifting or strenuous activity, and maintaining good hygiene in the area. It is also important to attend all follow-up appointments with your healthcare provider to monitor progress and address any concerns.

Suitable For

Patients who are typically recommended rectal prolapse surgery are those who have not responded to conservative treatments such as dietary modifications, pelvic floor exercises, and medication. In pediatric patients, surgery may be considered if the rectal prolapse is severe, recurrent, causing significant symptoms, or impacting quality of life. The decision to proceed with surgery is made on a case-by-case basis, taking into consideration the patient’s age, overall health, and specific symptoms. The most common surgical options for rectal prolapse in children include injection sclerotherapy, perineal repairs, and laparoscopic rectopexy with mesh. These procedures have shown high success rates and low complication rates in pediatric patients.

Timeline

Before rectal prolapse surgery:

  • Patient may experience symptoms such as rectal bleeding, pain, constipation, and protrusion of the rectum
  • Patient may undergo conservative treatments such as dietary changes, pelvic floor exercises, and medications
  • If conservative treatments are unsuccessful, patient may be referred for surgical intervention

After rectal prolapse surgery:

  • Patient undergoes either injection sclerotherapy, perineal repair, or laparoscopic rectopexy with mesh
  • Initial success rates for injection sclerotherapy are around 79.5%, with ethyl alcohol being the preferred sclerosing agent
  • Perineal repairs have success rates ranging from 60.8% to 100%
  • Laparoscopic rectopexy with mesh has an overall success rate of 96.1%
  • Postoperative complications from all procedures are comparable, with low complication rates reported
  • Patient may experience relief from symptoms such as rectal prolapse and associated pain, bleeding, and constipation

What to Ask Your Doctor

  1. What are the different treatment options available for rectal prolapse surgery in children?
  2. What are the risks and benefits associated with each treatment option?
  3. How successful is the specific surgical procedure you are recommending in treating rectal prolapse in children?
  4. What is the recovery process like after rectal prolapse surgery?
  5. Are there any long-term effects or complications to be aware of following surgery?
  6. How many of these procedures have you performed in the past and what is your success rate?
  7. Are there any alternative treatments or non-surgical options that could be considered?
  8. What is the expected outcome for my child following rectal prolapse surgery?
  9. What steps can be taken to prevent recurrence of rectal prolapse in the future?
  10. Are there any lifestyle changes or modifications that need to be made post-surgery?

Reference

Authors: Morrison ZD, LaPlant M, Hess D, Segura B, Saltzman D. Journal: J Pediatr Surg. 2019 Sep;54(9):1782-1787. doi: 10.1016/j.jpedsurg.2019.03.002. Epub 2019 Mar 7. PMID: 30905414