Our Summary

This study focused on understanding the occurrence and best management of rectal prolapse (where the rectum slips out of place) in children who have had surgery to correct an anorectal malformation (ARM, a birth defect affecting the anus and rectum). The researchers analyzed data from a pediatric health registry.

Out of the 1,140 patients they looked at, 163 (14.3%) developed rectal prolapse after their ARM surgery. The analysis showed that rectal prolapse was more likely in boys, patients with sacral abnormalities (issues with the lower part of the spine), and those with more complex ARM types or who had undergone laparoscopic ARM repairs (a less invasive surgical technique).

Certain types of ARM had particularly high rates of prolapse, including rectourethral-prostatic fistula, rectovesical/bladder neck fistula, and cloaca.

Of those who developed prolapse, 67.5% had surgery to manage it. After this surgery, 24.5% of patients developed anoplasty strictures (a narrowing of the anus).

When the researchers took into account the type of ARM and the hospital, they found that laparoscopic ARM repair wasn’t significantly linked to prolapse.

The study concluded that a significant number of patients develop rectal prolapse after ARM surgery, and that the risk is higher in boys, those with complex ARMs, and those with sacral abnormalities. More research is needed to understand the best way to manage and treat prolapse in these patients.

FAQs

  1. What percentage of children developed rectal prolapse after their ARM surgery in this study?
  2. Does the type of ARM or the use of laparoscopic repair significantly affect the likelihood of prolapse?
  3. What percentage of patients who developed prolapse had to undergo surgery to manage it and how many of them developed anoplasty strictures afterwards?

Doctor’s Tip

One helpful tip a doctor might tell a patient about rectal prolapse surgery is to follow post-operative care instructions carefully to reduce the risk of complications, such as anoplasty strictures. It is important to take prescribed medications, attend follow-up appointments, and avoid strenuous activities until fully healed. Additionally, maintaining a healthy diet high in fiber and staying hydrated can help prevent constipation, which can exacerbate rectal prolapse.

Suitable For

Overall, rectal prolapse surgery is typically recommended for patients who have developed rectal prolapse after ARM surgery and are experiencing symptoms such as rectal protrusion, difficulty with bowel movements, and fecal incontinence. Patients with complex ARM types, sacral abnormalities, and those who are male may be at a higher risk for developing rectal prolapse and may benefit from surgical intervention. It is important for healthcare providers to assess each patient individually and consider their specific medical history and risk factors before recommending rectal prolapse surgery.

Timeline

In summary, before rectal prolapse surgery, a patient may experience symptoms such as the rectum slipping out of place, discomfort, and difficulty with bowel movements. After surgery, the patient may experience relief from these symptoms but may also develop complications such as anoplasty strictures. The patient may require ongoing monitoring and follow-up care to ensure the best outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about rectal prolapse surgery include:

  1. What are the risks and benefits of rectal prolapse surgery in my specific case?
  2. What is the success rate of this surgery for patients who have had ARM surgery in the past?
  3. Are there any alternative treatments or non-surgical options for managing rectal prolapse?
  4. What is the recovery process like after rectal prolapse surgery?
  5. Are there any potential complications or long-term effects I should be aware of?
  6. Will I need additional surgeries or treatments in the future to manage rectal prolapse?
  7. How experienced are you in performing rectal prolapse surgery, particularly in patients who have had ARM surgery?
  8. Can you provide me with any information or resources to help me better understand the procedure and what to expect?
  9. What lifestyle changes or precautions should I take before and after rectal prolapse surgery?
  10. Are there any specific factors in my medical history or condition that may affect the outcome of the surgery?

Reference

Authors: Iantorno SE, Rollins MD, Austin K, Avansino JR, Badillo A, Calkins CM, Crady RC, Dickie BH, Durham MM, Frischer JS, Fuller MK, Grabowski JE, Ralls MW, Reeder RW, Rentea RM, Saadai P, Wood RJ, van Leeuwen KD, Short SS; Pediatric Colorectal and Pelvic Learning Consortium. Journal: J Pediatr Surg. 2023 Aug;58(8):1588-1593. doi: 10.1016/j.jpedsurg.2023.04.010. Epub 2023 Apr 20. PMID: 37173214