Our Summary

This research paper looks at the issue of rectal prolapse, which means the rectum falls down or slips out of its normal place, in adults who were born with anorectal malformations (ARMs). This condition can create certain unique challenges for surgery due to the changed structure of the pelvic area, previous reconstructive surgeries, and problems with bowel function.

The researchers reviewed previous studies on standard methods for repairing rectal prolapse in adults, and also looked at the medical records of adult ARM patients who had prolapse repair surgery between 2018 and 2023 at one specific medical center. They gathered data on the patients’ age, gender, type of ARM, characteristics of the prolapse, the surgical procedures used, and the results of those surgeries.

They found that 17 adult ARM patients (59% female, average age 30) had prolapse repair surgery. Most of these patients (88%) were treated with a modified version of a surgical procedure called the Altemeier procedure, while 12% had a modified version of a procedure called the Delorme procedure. Other methods were not used because of the changed anatomy and the risk to the body’s ability to control bowel movements.

When the researchers checked up on these patients around a year and a half later, they found that two patients (12%) had a minor recurrence of the prolapse.

The conclusions of the study were that the modified Delorme or Altemeier procedures were safe and effective for adult ARM patients with rectal prolapse. However, they also stressed that surgical strategies need to be personalized for each individual patient to take into account the complicated anatomy and functional considerations in this group of patients.

FAQs

  1. What is the most common surgical procedure for rectal prolapse in adults with anorectal malformations (ARMs)?
  2. Why are rectopexy or rectosigmoid resection not usually performed in adult ARM patients with rectal prolapse?
  3. What is the recurrence rate of rectal prolapse after surgery in adult ARM patients?

Doctor’s Tip

One helpful tip a doctor might tell a patient about rectal prolapse surgery is to follow post-operative care instructions carefully, including avoiding heavy lifting and strenuous activities for several weeks to allow for proper healing and to reduce the risk of recurrence. It is also important to eat a healthy diet high in fiber and stay hydrated to prevent constipation, which can put strain on the surgical site. Lastly, keep regular follow-up appointments with your doctor to monitor your recovery and address any concerns promptly.

Suitable For

Rectal prolapse surgery is typically recommended for patients with persistent symptoms such as rectal bleeding, fecal incontinence, chronic constipation, and discomfort or pain related to the prolapse. Patients who have failed conservative treatments such as dietary modifications, pelvic floor exercises, and medications may also be candidates for surgery. Additionally, patients with severe or recurrent rectal prolapse, or those with associated conditions such as rectocele, enterocele, or pelvic floor dysfunction, may benefit from surgical intervention. It is important for patients to undergo a thorough evaluation by a colorectal surgeon to determine the most appropriate treatment approach based on their individual circumstances.

Timeline

Before rectal prolapse surgery:

  1. Patient experiences symptoms of rectal prolapse such as feeling a bulge or protrusion from the rectum.
  2. Patient may undergo diagnostic tests such as a physical exam, colonoscopy, or imaging studies to confirm the diagnosis.
  3. Patient may undergo conservative treatments such as pelvic floor exercises, dietary changes, or the use of stool softeners.
  4. If conservative treatments are ineffective, patient may be recommended for surgical intervention.

After rectal prolapse surgery:

  1. Patient undergoes the chosen surgical procedure (e.g. modified Altemeier or modified Delorme procedure) to repair the rectal prolapse.
  2. Patient is monitored post-operatively for complications and to ensure proper healing.
  3. Patient may experience some discomfort and require pain medication during the recovery period.
  4. Patient gradually resumes normal activities and follows a modified diet as recommended by their healthcare provider.
  5. Patient attends follow-up appointments to monitor for recurrence and assess long-term outcomes of the surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with rectal prolapse surgery in adults with anorectal malformations?

  2. How will my prior reconstructions and altered pelvic anatomy affect the surgical approach for rectal prolapse repair?

  3. What is the expected recovery time and post-operative care for rectal prolapse surgery in this patient population?

  4. Will I need any additional procedures or treatments to address the underlying anorectal malformation in conjunction with the rectal prolapse repair?

  5. How likely is it that the rectal prolapse will recur after surgery, and what steps can be taken to minimize this risk?

  6. Are there any specific dietary or lifestyle changes I should make before or after the surgery to support successful outcomes?

  7. What are the long-term implications for bowel function and continence following rectal prolapse surgery in adults with anorectal malformations?

  8. How experienced is the surgical team in performing rectal prolapse surgery in patients with anorectal malformations, and what outcomes have they achieved in similar cases?

  9. Are there any alternative treatment options or surgical techniques that may be better suited to my specific condition and anatomy?

  10. What follow-up care and monitoring will be necessary after the surgery to ensure the best possible outcomes for rectal prolapse repair in this patient population?

Reference

Authors: Melkonian V, de la Torre L, Evans L, Ketzer J, Pena A, Bischoff A. Journal: Pediatr Surg Int. 2025 Jun 15;41(1):171. doi: 10.1007/s00383-025-06077-9. PMID: 40517363