From
StayCurrentMD
Rectal Prolapse Rapid Fire: Update Course 2015
With CCHMC Pediatric Surgery
Part of
Rectal Prolapse 5 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
There is a tremendous amount of literature on rectal prolapse in the pediatric population — the speaker is being ironic, indicating limited pediatric literature.
The speaker was trained to test for cystic fibrosis in rectal prolapse patients and answered board questions accordingly, but has never picked up a CF case through rectal prolapse presentation in practice.
Initial medical management for rectal prolapse includes treating constipation and limiting toilet sitting time to 5 minutes.
The speaker performs resection and rectopexy for rectal prolapse when medical management fails.
Anal cerclage works well for rectal prolapse, especially in small babies.
Laparoscopic rectopexy to the promontory is performed, with resection if there is a huge redundant segment.
Re-operating on patients after sclerosing agent injection is difficult.
The speaker has not had success with sclerosing agents and cannot recall a patient who did not ultimately require rectopexy.
The speaker has one patient operated on twice through the abdomen, then treated with ventral mesh rectopexy, which has solved the problem so far.
Ventral mesh rectopexy involves placing mesh on the anterior surface of the rectum, elevating the rectum without posterior dissection, and tacking the mesh to the sacral promontory; can be done open or laparoscopically.
Reading the literature, many other practitioners have also not picked up CF patients through rectal prolapse workup, though CF patients may present with prolapse.
According to the literature (mostly adult but some pediatric), transabdominal approaches have approximately 5% recurrence rate.
Transanal approaches (transanal pull-through or Altmeier procedure) have 15-20% recurrence rate according to the literature.
Resection and rectopexy may be better for patients with difficult-to-control constipation, but has a higher complication rate than rectopexy alone.
Current literature reports patients going home the next day or even same day after rectopexy.
Ventral mesh rectopexy is a newer procedure in adult literature, popularized by the Cleveland Clinic and other centers.
There are reports of mesh erosion in the pediatric population, making surgeons cautious about mesh use.
The pathophysiology theory for pediatric rectal prolapse is that the angle of the rectum to the anal canal is straighter in younger patients and becomes more angled with age; ventral mesh rectopexy attempts to change this angulation.
Ventral mesh rectopexy is primarily used in older adult women with pelvic floor relaxation issues.