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Rectal Prolapse
Everything in the library about rectal prolapse — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
1 item
Rectal Prolapse Repair Following a Posterior Sagittal Anorectoplasty
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Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital
video4:55 · Jan 2025
Evidence & Research
1 item
Morbidity of Rectal Prolapse Repair After Surgery for Anorectal Malformation
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Megan A. Read, Liese C.C. Pruitt, Brenna Rachwal, Kristine L. Griffina, Richard J. Wood, Alessandra C. Gasio
Purpose
Rectal prolapse is a known complication of surgery for anorectal malformations (ARM), however morbidity of prolapse r
video0:39 · Sep 2025
Case-Based Learning
1 item
Colorectal Quiz Episode 2: When to redo a PSARP
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In the second installment of the Colorectal quiz, Dr. Jason Frischer and Dr. Marc Levitt discuss a topic of debate - when is the right time to redo an anorectoplasty? Listen as they walk you through their thought process on 2 different case
podcast18:15 · Jan 2021
In-Depth Reviews
2 items
Rectal Prolapse Rapid Fire: Update Course 2015
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Dr. Jason Frischer of Cincinnati Children's Hospital Medical Center presents on rectal prolapse.
video5:40 · Jan 2019
Update Course Rewind: 2020 Colorectal Part 2
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Did you miss our annual Update Course? Don't worry, we are summarizing our favorite sessions from years past. In this episode, Dr. Eunice Huang and Dr. Megan Durham talk you through the workup and management for rectal prolapse. Mark your c
podcast11:01 · Mar 2021
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Morbidity of Rectal Prolapse Repair After Surgery for Anorectal Malformation
A study examined 85 children treated for rectal prolapse after anorectal malformation surgery
Host summaryLizzie Lee summarizing a resource — not the host's own clinical position0:11 ↗
Approximately 30% of children had recurrence of prolapse requiring another repair
Host summaryLizzie Lee summarizing a resource — not the host's own clinical position0:16 ↗
Children without symptoms from prolapse at initial presentation were more likely to develop stricture later
Host summaryLizzie Lee summarizing a resource — not the host's own clinical position0:20 ↗
Surgical repair of asymptomatic rectal prolapse may not be indicated because the treatment itself carries risks
Host summaryLizzie Lee summarizing a resource — not the host's own clinical position0:26 ↗
Colorectal Quiz Episode 2: When to redo a PSARP
For anorectoplasty, if you don't get it perfect, you might not have the best outcomes, which separates it from other surgical procedures.
opinionJason Frischer0:00 ↗
A lot of surgeons agree that oftentimes your first shot might be your only shot to give this patient a good outcome and the right anatomy.
Host summaryJason Frischer summarizes what Dr. Marc Levitt said — not the host's own clinical position0:40 ↗
The original malformation in Case 1 was a prostatic fistula.
clinicalMarc Levitt4:30 ↗
The patient in Case 1 has a tethered cord and a sacral ratio of 0.66.
clinicalMarc Levitt4:40 ↗
The family doesn't really care how technically elegant is your analplasty. What they care about is whether that analplasty that you make is going to work and is the child going to be clean and in normal underwear.
opinionJason Frischer5:50 ↗
The higher the malformation, the worse the prognosis.
clinicalJason Frischer6:25 ↗
A sacrum ratio of 0.7 or greater usually means normal or close to normal sphincters and good muscle tone, indicating that spine innervation of that area is probably good.
clinicalJason Frischer6:35 ↗
Patients can come with associated spinal anomaly, most commonly tethered cord, but the worst is a myelomeningocele, and those patients have much more trouble with continence.
clinicalJason Frischer6:40 ↗
Visual cues for identifying correct sphincter location include the anal dimple, a midline raised area where the sphincters are, the ellipse, color change, indentation or raised area, and appropriate perineal body length.
clinicalMarc Levitt7:29 ↗
It's amazingly common to have a mislocated anus, either because the surgeon misses where the center is during laparoscopic pull-through or opens the PSARP incision first.
clinicalJason Frischer7:44 ↗
A key pitfall is opening the PSARP incision first; instead, mark the sphincters first, then open the PSARP so you don't get confused when placing the anoplasty in the correct location.
clinicalJason Frischer8:05 ↗
Case 2 patient was born with a vestibular fistula, has a normal spine and an excellent sacrum, indicating a much better prognosis for bowel control.
clinicalMarc Levitt8:40 ↗
The electrical stimulator used is the same one that anesthesia uses for their train of four, with an inexpensive connection with little pins.
clinicalMarc Levitt9:50 ↗
You have to tell your anesthesiologist not to give skeletal muscle relaxant because the stimulator is a little bit weaker than the traditional stimulator.
clinicalMarc Levitt10:10 ↗
In higher malformations such as a bladder neck fistula in a boy, the sphincter complex isn't always where you think it's going to be and is sometimes more anterior than anticipated.
clinicalJason Frischer10:19 ↗
The vast majority of patients who get redos had mislocation, followed by stricture, then less common reasons including remnant of the original fistula (roof), rectal prolapse, and others.
Host summaryMarc Levitt summarizes what Dr. Jason Frischer said — not the host's own clinical position12:00 ↗
Quality of life improved with a redo operation.
Host summaryMarc Levitt summarizes what Dr. Jason Frischer said — not the host's own clinical position12:30 ↗
Patients had an improved ability to achieve continence after redo operations.
Host summaryMarc Levitt summarizes what Dr. Jason Frischer said — not the host's own clinical position12:40 ↗
In the JPS study, 20% of patients with a poor sacrum or poor spine actually developed bowel control after their redo.
Host summaryMarc Levitt summarizes what Dr. Jason Frischer said — not the host's own clinical position12:55 ↗
Patients with good potential (good sacrum and good spine) did extremely well after redo operations.
Host summaryMarc Levitt summarizes what Dr. Jason Frischer said — not the host's own clinical position13:10 ↗
Patients who did not develop voluntary bowel movements after redo were still able to be clean with a bowel management program using enemas or antegrade via a Malone.
Host summaryMarc Levitt summarizes what Dr. Jason Frischer said — not the host's own clinical position12:50 ↗
The average age of patients in the JPS study is about three and a half years, give or take.
Host summaryMarc Levitt summarizes what Dr. Jason Frischer said — not the host's own clinical position13:10 ↗
If you know the anatomy is off, you should do the redo, and there's an advantage to getting the anatomy right the younger the child is.
opinionMarc Levitt13:28 ↗
For a two-year-old with a mislocated anus or bad prolapse, offer a redo and let them live in diapers for a year or two with better anatomy, then see if they can successfully potty train.
opinionMarc Levitt13:50 ↗
Many patients present after the age of potty training because they're incontinent, and evaluation reveals the reason is they don't have the best operation—their anus isn't in the right place.
clinicalMarc Levitt14:20 ↗
For patients presenting with incontinence after potty training age, do the redo and usually add a Malone at the same time so they can learn how to get control with their new anatomy before attempting voluntary bowel movements.
opinionMarc Levitt14:30 ↗
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