What is the role of laparoscopy in the treatment of pediatric rectal prolapse?

Updated: Nov 12, 2018
  • Author: Jaime Shalkow, MD, FACS; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Virtually every type of open transabdominal approach for rectal prolapse has been tried laparoscopically. Some researchers have shown adequate results in laparoscopic repair of rectal prolapse in children, even as an outpatient procedure, thus it promises to become the criterion standard for the management of full-thickness rectal prolapse in children.

The rate of surgical complications is 0-3%, and the recurrence rate ranges from 0-10%. Regarding complications, recurrence rate, and correction of the associated rectal dysfunction, its effectiveness is comparable to that of an open approach. [24, 66]

Lesser rates of adhesions formation can be expected. It is associated with less postoperative pain and shorter hospital stay with excellent cosmesis. [67]

Current laparoscopic surgical techniques include suture rectopexy, stapled rectopexy, posterior mesh rectopexy, and resection of the sigmoid colon with colorectal anastomosis with or without rectopexy. [68, 69, 70]

According to Kairaluoma et al (2003), the main advantages of a laparoscopic approach are a shortened hospital stay and reduced intraoperative blood loss. [71] The recurrence rate is not increased in the short term. Less postoperative pain, better cosmesis, and a faster recovery of the bowel function and introduction of diet have also been reported. [72, 73, 74]

Koivusalo et al performed 8 laparoscopic sacrorectopexies with good results. [73] They reported 2 patients with postoperative constipation. It appears that patients have less constipation and incontinence if the lateral rectal ligaments can be preserved; however, this requires further analysis.

D’Hoore and Penninckx described a laparoscopic ventral rectal colpopexy technique for the repair of rectal prolapse and enterocele. [75]

Delaney reported 109 laparoscopic repairs in adults. [72] Hospital stay was 3 days (compared with 6 days for open surgery), and recurrence rates were 8% for laparoscopic surgery compared with 5% for open surgery. The procedure is described as follows:

  1. The presacral space is entered, and the rectum is mobilized

  2. A precut mesh is passed down a port and tacked to the sacral promontory in the midline

  3. The edges are then sutured to the lateral mesorectal tissue for support

  4. In patients having a resection (those with slow intestinal transit and severe constipation), the upper rectum is transected with an endoscopic stapler and pulled out through a small left lower quadrant muscle-splitting incision

  5. The resection is completed, and the anvil of a circular stapler is inserted in the proximal bowel before it is returned to the abdominal cavity

  6. The anastomosis to the rectal stump is performed before the lateral mesorectal tissue is sutured to the promontory

Saxena et al successfully treated a 22-month-old girl by using laparoscopic simple suture rectopexy with 5-mm instruments and placement of 3-0 nonabsorbable sutures on either side of the rectum to secure it to the presacral fascia. [76] No blood loss occurred, and the procedure was completed without complications. The child was followed up for 24 months, with good results. Similar results were seen in a study by Awad et al that evaluated laparoscopic suture rectopexy on 20 pediatric patients who required laparoscopic suture rectopexy. The study found that the median length of hospital stay was 1 day and only one patient had full-thickness recurrence. [77]

Gomez –Ferreira et al described a modified Orr-Loygue mesh rectopexy technique for recurrent, non-resolving prolapse. The technique involves excision of the Douglas pouch and tension free suspension of the rectum using non-absorbable prerectal mesh. [78]


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