Transanal endorectal approach for the treatment of idiopathic rectal prolapse in children: Experience with the modified Delorme's procedure

Hemi-circumferential mucosal resection and anastomosis procedure for rectal prolapse following anorectoplasty for anorectal malformations

PURPOSE

Rectal prolapse after radical surgery for anorectal malformations (ARMs) is a common postoperative complication that causes bleeding and stenosis, and sometimes requires surgical treatment. Different surgical techniques have been reported, but most are associated with high recurrence rates and a long postoperative stay. We performed the hemi-circumferential mucosal resection and anastomosis procedure (HCMR) to preserve anal muscle and anal function. Here, we report the success of our minimally invasive surgical approach to correct rectal prolapse in patients with ARMs.

METHODS

The subjects of this retrospective review were patients who underwent HCMR for rectal prolapse after radical surgery for ARMs between January, 2014 and August, 2021. HCMR involves rectal mucosal resection without muscle plication.

RESULTS

A collective 15 HCMR procedures were performed in 10 patients. The median age at repair was 1.8 years (range, 10 months-18 years). The median operation time and postoperative length of stay were 46 min (range, 17-85 min) and 3 days (range, 1-7 days), respectively. The median postoperative observation period was 3 years 4 months (range, 8 months-7 years 10 months) and no complications or recurrences were observed.

CONCLUSIONS

HCMR is a safe and effective surgical treatment for rectal prolapse after radical operation for ARMs, which is minimally invasive and preserves rectal muscle and function.

Abdominoperineal anoplasty with use of a rectal fistula as a substitute vagina in a cloacal malformation associated with absence of the vagina: short-term follow-up

We report herein a patient with a cloacal malformation and an absent vagina. The patient underwent colostomy on Day 1 of life. At 7 months of age, fistulography of the cloaca showed a common channel >3 cm in length; a vagina was not visible. At the age of 11 months, the patient underwent abdominoperineal anoplasty with the repurposing of her rectal fistula as a substitute vagina. Intraoperative examination revealed a bicornuate uterus and bilateral ovaries. The rectum was resected 7 cm at the confluence of the cloaca. The colonic stump was pulled through a newly created anal canal and an anoplasty was performed. Two months after this procedure, the patient experienced anal prolapse. At the age of 17 months, she underwent partial urogenital mobilization and a modified Delorme operation, and 5 months later the colostomy was closed. At present, this patient is 3 years old and doing well.

Transanal rectal mucosectomy and muscular plication: A new technique for rectal prolapse in patients with an anorectal malformation

BACKGROUND

Rectal prolapse after repair of an anorectal malformation (ARM) occurs at a frequency of 3.8% to 60.0%. Different techniques have been described for repair, with a recurrence rate of up to 33%. We aimed to describe a new technique for rectal prolapse and present its results.

METHODS

A retrospective review of our database identified 14 patients with rectal prolapse after posterior sagittal anorectoplasty (PSARP) for an ARM. The study was performed from January 2014 until March 2020. All patients underwent transanal rectal mucosectomy and muscular plication (TRMMP).

RESULTS

All but one patient had PSARP, and the remaining patient had laparoscopic-assisted PSARP. The mean age at repair was 4 years and 8 months (range, 1-12 years). One patient had three previous repair attempts, and another five had only one attempt. The mean follow-up was 2 years and 5 months (range, 3 months to 5 years and 7 months). None of the patients experienced prolapse recurrence or postoperative complications.

CONCLUSION

This preliminary report showed that TRMMP can be used for rectal prolapse, without the risk of recurrence or complications. Pediatric surgeons may consider this technique as another option for the treatment of rectal prolapse in patients with an ARM.