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McNevin MS. Evaluation and Management of Rectal Prolapse. Surg Clin North Am 2024; 104:557-564. [PMID: 38677820 DOI: 10.1016/j.suc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Rectal prolapse, or procidentia, is a common pathology for the practicing colorectal surgeon. It is associated with lifestyle limiting symptoms for the patient and frequently co-exists with other types of pelvic prolapse making multidisciplinary management key. It is primarily managed with surgical reconstruction. A number of operative approaches exist, and the optimum procedure is varied dependent upon patient characteristics.
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Affiliation(s)
- Michael Shane McNevin
- GI, Trauma and Endocrine Surgery, Department of Surgery, University of Colorado, Mail Stop C313, Academic Office 1, 12631 East 17th Avenue, Room 6001, Aurora, CO 80045, USA.
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Gad M, Dessouky MN, Abdullateef KS, Abdelazim O, Fares AE, Kaddah SN, Ragab M. Management of Complete Persistent Rectal Prolapse in Children: A Comparative Study Between Mesh Repair Versus Suturing Rectopexy. Afr J Paediatr Surg 2024; 21:28-33. [PMID: 38259016 PMCID: PMC10903731 DOI: 10.4103/ajps.ajps_92_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/13/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The primary treatment of rectal prolapse is non-operative. Surgical intervention is needed in long-standing intractable cases of rectal prolapse, rectal pain/bleeding/ulceration and prolapse that needs frequent manual or difficult reduction. The aim of this study was to compare the efficacy and outcome of laparoscopic ventral mesh rectopexy versus laparoscopic suture rectopexy in the management of persistent rectal prolapse in children not responding to conservative management and/or recurrent after sclerotherapy or anal encirclement. MATERIALS AND METHODS Twenty-four cases were randomised into two groups at the ratio of 1:1, Group 1 patients were managed by laparoscopic ventral mesh rectopexy, whereas Group 2 cases were managed by laparoscopic suture rectopexy. Patients with primary surgical conditions such as anorectal malformations, Hirschsprung's disease, rectal polyps or masses and Ectopia Vesicae were excluded from the study. Inclusion criteria were complete rectal prolapse cases with failed medical treatment for at least 6 months and/or recurrent after injection sclerotherapy or anal encirclement. RESULTS In the mesh rectopexy group, one case had recurrence in the form of partial prolapse 3 weeks postoperatively which improved 2 months postoperatively with conservative management, one case had bleeding per rectum 2 months postoperatively, stool analysis was done revealing parasitic infestation which was treated medically. In the suture rectopexy group, one case had one attack of bleeding per rectum on the 2nd day postoperatively which resolved spontaneously and one case was readmitted on the 5th day postoperatively for non-bilious vomiting which improved by medical treatment. No recurrent cases of complete rectal prolapse were reported in both groups. CONCLUSION Laparoscopic rectopexy can be an effective modality for the treatment of refractory complete rectal prolapse in children. It is effective, safe and easy. Although the current study has shown that laparoscopic suture rectopexy and mesh rectopexy have nearly the same results, a larger number of patients are needed to compare more deeply between the two groups.
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Affiliation(s)
- Mostafa Gad
- Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Mostafa Nabil Dessouky
- Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Khaled Salah Abdullateef
- Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Osama Abdelazim
- Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Ahmed E. Fares
- Departement of Pediatric Surgery, Fayoum University, Fayoum, Egypt
| | - Sherif Nabhan Kaddah
- Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Moutaz Ragab
- Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
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Kelley JK, Hagen ER, Gurland B, Stevenson ARL, Ogilvie JW. The international variability of surgery for rectal prolapse. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000198. [PMID: 38020494 PMCID: PMC10649678 DOI: 10.1136/bmjsit-2023-000198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Objective There is a lack of consensus regarding the optimal approach for patients with full-thickness rectal prolapse. The aim of this international survey was to assess the patterns in treatment of rectal prolapse. Design A 23-question survey was distributed to the Pelvic Floor Consortium of the American Society of Colorectal Surgeons, the Colorectal Surgical Society of Australia and New Zealand, and the Pelvic Floor Society. Questions pertained to surgeon and practice demographics, preoperative evaluation, procedural preferences, and educational needs. Setting Electronic survey distributed to colorectal surgeons of diverse practice settings. Participants 249 colorectal surgeons responded to the survey, 65% of which were male. There was wide variability in age, years in practice, and practice setting. Main outcome measures Responses to questions regarding preoperative workup preferences and clinical scenarios. Results In preoperative evaluation, 19% would perform anorectal physiology testing and 70% would evaluate for concomitant pelvic organ prolapse. In a healthy patient, 90% would perform a minimally invasive abdominal approach, including ventral rectopexy (56%), suture rectopexy (31%), mesh rectopexy (6%) and resection rectopexy (5%). In terms of ventral rectopexy, surgeons in the Americas preferred a synthetic mesh (61.9% vs 38.1%, p=0.59) whereas surgeons from Australasia preferred biologic grafts (75% vs 25%, p<0.01). In an older patient with comorbidities 81% would perform a perineal approach. Procedure preference (Delormes vs Altmeier) varied according to location (Australasia, 85.9% vs 14.1%; Europe, 75.3% vs 24.7%; Americas, 14.1% vs 85.9%). Most participants were interested in education regarding surgical approaches, however there is wide variability in preferred methods. Conclusion There is significant variability in the preoperative evaluation and surgery performed for rectal prolapse. Given the lack of consensus, it is not surprising that most surgeons desire further education on the topic.
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Affiliation(s)
- Jesse K Kelley
- General Surgery Residency, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
- General Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - Edward R Hagen
- Colorectal Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - Brooke Gurland
- Colorectal Surgery, Stanford Medicine, Stanford, California, USA
| | - Andrew RL Stevenson
- Colorectal Surgery, St Vincent’s Private Hospital Northside, Brisbane, Queensland, Australia
| | - James W Ogilvie
- Colorectal Surgery, Corewell Health, Grand Rapids, Michigan, USA
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Rincon-Cruz L, Staffa SJ, Dickie B, Nandivada P. Influence of Initial Treatment Strategy on Outcomes for Children With Rectal Prolapse. J Pediatr Gastroenterol Nutr 2023; 77:603-609. [PMID: 37889618 DOI: 10.1097/mpg.0000000000003924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE Pediatric rectal prolapse is a common and often self-limited condition with multiple management options. Selecting the optimal approach requires personalization and remains a challenge for pediatricians and pediatric surgeons. METHODS A single-center retrospective review of 67 children with rectal prolapse undergoing surgical evaluation between 2010 and 2021. Patients with anorectal malformations, Hirschsprung disease, inflammatory bowel disease, and cystic fibrosis were excluded. We used multivariable logistic regression to compare medical management, sclerotherapy, and surgical correction (rectopexy or transanal resection) as initial treatment strategies, with a primary endpoint of prolapse resolution. RESULTS Younger patients (<5 years) were more likely to be initially treated with medical management alone (P < 0.001). Patients with a psychiatric diagnosis were more likely to be offered either sclerotherapy or surgery upfront (P = 0.009). The resolution rate with surgery as initial management was 79% (n = 11/14). The resolution rate with sclerotherapy as initial management was 54% (n = 13/24), with 33% (n = 8/24) resolving with sclerotherapy alone and 21% (n = 5/24) resolving after a subsequent surgical procedure (P = 0.011). Patients who underwent initial surgical management had an adjusted odds ratio of 8.0 (95% CI: 1.1-59.1; P = 0.042) for resolution of prolapse compared to patients who underwent sclerotherapy initially. Markers of severity (bleeding, need for manual reduction) were not associated with initial therapy offered (P = 0.064). CONCLUSIONS Surgical intervention (sclerotherapy, rectopexy, transanal resection) resolved rectal prolapse in most children (63%). Surgery as an initial management approach had a significantly higher success rate than sclerotherapy, even after controlling for severity of disease, psychiatric diagnosis, need for manual reduction, and age.
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Short SS, Wynne EK, Zobell S, Gaddis K, Rollins MD. Most children experience resolution of idiopathic pediatric rectal prolapse with bowel management alone. J Pediatr Surg 2022; 57:354-358. [PMID: 34872729 DOI: 10.1016/j.jpedsurg.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/24/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies in children with idiopathic rectal prolapse report up to 48% require surgical intervention to manage refractory disease. We sought to examine outcomes of our non-surgical approach to managing rectal prolapse using a bowel management program. METHODS A retrospective review was performed for all children with the diagnosis of rectal prolapse between 2011 and 2020. Children with a rectal polyp or hemorrhoid were excluded. RESULTS 47 children with rectal prolapse were identified (median age at diagnosis of 4 years (IQR 3,7.75); age ≤ 4 years n = 30; age > 4 years n = 17). Associated diagnoses included constipation (n = 45, 96%) and psychiatric diagnoses (n = 7, 14%). Children underwent a bowel management program including stimulant laxatives in 44 (94%) and osmotic laxatives in 2 (4%). Median follow-up time was 181 days (IQR 77, 238). Median time to resolution of rectal prolapse was 9 months (IQR 4, 13) with a maximum time to resolution of 31 months. We compared children ≤ 4 years old (Group A) to those > 4 years old (Group B). Psychiatric diagnoses were less common in Group A (3.5 vs. 38.9%, p = 0.003). Median time to spontaneous resolution was 6.5 months (IQR 3.5, 9.5) in Group A versus 13.5 (IQR 4, 16) months in Group B, p = 0.13. No differences in surgical intervention were identified. Three (6.4%) patients required surgery for prolapse. CONCLUSIONS A bowel management program is an effective treatment for most children with rectal prolapse. This data suggests that surgical intervention is unnecessary in most children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Scott S Short
- Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States.
| | - Elisabeth K Wynne
- Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
| | - Sarah Zobell
- Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
| | - Katherine Gaddis
- Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
| | - Michael D Rollins
- Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
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Tecos ME, Ballweg M, Hanna A, Thomas P, Zarroug A. Unique presentation of rectal prolapse as alarm symptom for pediatric abdominal compartment syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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The utilization of telehealth during the COVID-19 pandemic: An American Pediatric Surgical Association survey. J Pediatr Surg 2022; 57:1391-1397. [PMID: 35249736 PMCID: PMC8828297 DOI: 10.1016/j.jpedsurg.2022.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Limited in-person visits during the COVID-19 pandemic, with liberal reimbursement policies, resulted in increased use of video conferencing (hereby described as telehealth) for patient care. To better understand the impact on pediatric surgeons and their patients, we surveyed members of the American Pediatric Surgical Association (APSA) regarding telehealth use prior to and during the pandemic. METHODS An iteratively developed survey was sent to all active, non-trainee surgeons within APSA during March 2021. RESULTS Of 247 responses (23% response rate), 154 (62%) began using telehealth during the pandemic. In addition to the 101 (60.5%) respondents who felt telehealth had a positive impact on their clinical practice, 161 (74.2%) felt that it had a positive impact on their patients' satisfaction. The most common barriers to telehealth use prior to COVID-19 were availability of technology (39.3%), patient access to technology (36.0%), and lack of reimbursement (32.0%). These barriers became less substantial during the pandemic. Most respondents (95.3%) indicated they would continue using telehealth post-pandemic if it remains appropriately reimbursed. CONCLUSIONS The majority of pediatric surgeons implemented telehealth during the COVID-19 pandemic and endorsed a positive effect on their clinical practice as well as on patient satisfaction. An overwhelming majority would continue using this technology if reimbursement policies remain favorable.
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Benign anorectal disease in children: What do we know? Arch Pediatr 2022; 29:171-176. [DOI: 10.1016/j.arcped.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 10/31/2021] [Accepted: 01/30/2022] [Indexed: 11/19/2022]
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Rentea RM, Halleran DR, Gasior AC, Vilanova-Sanchez A, Ahmad H, Weaver L, Wood RJ, Levitt MA. A pediatric colorectal and pelvic reconstruction course improves content exposure for pediatric surgery fellows: A three-year consecutive study. J Pediatr Surg 2021; 56:2270-2276. [PMID: 33736877 DOI: 10.1016/j.jpedsurg.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Interactive courses play an important role in meeting the educational needs of pediatric surgical trainees. We investigated the impact of a multimodal pediatric colorectal and pelvic reconstruction course on pediatric surgery trainees. METHODS A retrospective evaluation was performed of pre- and post-course surveys for an annual colorectal and pelvic reconstruction course over 3 consecutive years (2017-2019). The course included didactic and case-based content, interactive questions, video, and live case demonstration, and a hands-on lab. Pre- and post-course surveys were distributed to participants. Comfort with operative/case procedures was scored on a 5-point Likert scale (1 uncomfortable, 5 very comfortable). The primary outcome was improved confidence and content knowledge for pediatric colorectal surgical conditions. RESULTS 165 pediatric surgical fellow participants with a 70 responses (42.4% response rate) comprised the cohort. Participants had limited advanced pediatric colorectal experience. At the time of the course, participants reported a median of 5 [3,10] Hirschsprung pull-throughs, 6 [3,10] anorectal malformation, and 1 [0,1] cloaca cases. Participants transitioned from discomfort to feeling comfortable with pediatric colorectal operative set-up and case management (pre-course 2 [2,3] and post-course 4 [4,5] p<0.001). CONCLUSION Pediatric surgery trainees report limited exposure to advanced pediatric colorectal and pelvic reconstruction cases and management during their pediatric surgical fellowship training but report improved content knowledge- and technical understanding of complex pediatric disorders upon completion of a dedicated course. The course is an important adjunct to the experience gained in pediatric surgery fellowship for achieving competency in managing patients with Hirschsprung disease, anorectal malformation, and cloacal reconstructions.
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Affiliation(s)
- Rebecca M Rentea
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH 43205, United States; Children's Mercy Hospital- Kansas City, Pediatric Surgery- Comprehensive Colorectal Center, 2401 Gillham Road, Kansas City, MO 64108, United States.
| | - Devin R Halleran
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH 43205, United States
| | - Alessandra C Gasior
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH 43205, United States
| | - Alejandra Vilanova-Sanchez
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH 43205, United States
| | - Hira Ahmad
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH 43205, United States
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH 43205, United States
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH 43205, United States
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC, United States
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Sarosi A, Coakley BA, Berman L, Mueller CM, Rialon KL, Brandt ML, Heiss K, Weintraub AS. A cross-sectional analysis of compassion fatigue, burnout, and compassion satisfaction in pediatric surgeons in the U.S. J Pediatr Surg 2021; 56:1276-1284. [PMID: 33589141 DOI: 10.1016/j.jpedsurg.2021.01.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND/PURPOSE To determine the prevalence of compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) and identify potential predictors of these phenomena in pediatric surgeons. METHODS The Compassion Fatigue and Satisfaction Self-Test and a survey of personal/professional characteristics were distributed electronically to American Pediatric Surgical Association members. Linear regression models for CF, BO, and CS as a function of potential risk factors were constructed. RESULTS The analyzeable study response rate was 25.7%. The prevalence of CF, BO, and CS was 22%, 24% and 22, respectively, which were similar to prevalences previously identified in pediatric subspecialists. Higher CF scores were significantly associated with: higher BO scores; solo practice; compensation; ≥5 operating days/week; current distress about a 'clinical situation'; mental health-care for work-related distress; and history of childhood surgery. Lower CF scores were significantly associated with 'talking with a life partner' about work-related distress. Higher BO scores were significantly associated with: higher CF scores; current distress about 'coworkers'; and 'keeping lawsuits confidential'. Lower BO scores were significantly associated with higher CS scores. CONCLUSIONS CF, BO, and CS are distinct but highly related entities. Pediatric surgeons experience these phenomena at similar rates to other pediatric subspecialists. Establishing local channels for physician peer support may be particularly impactful.
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Affiliation(s)
- Alex Sarosi
- Department of Surgery, Mount Sinai Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian A Coakley
- Department of Surgery, Mount Sinai Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Loren Berman
- Department of Surgery, Nemours AI DuPont Hospital for Children, Wilmington, DE, USA; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Kristy L Rialon
- Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mary L Brandt
- Department of Surgery, Children's Hospital of New Orleans, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kurt Heiss
- Department of Surgery, Children's Hospital of Atlanta, Emory University, Atlanta, GA, USA
| | - Andrea S Weintraub
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Box 1508, One Gustave L. Levy Place, New York, NY 10029, USA.
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Saadai P, Trappey AF, Langer JL. Surgical Management of Rectal Prolapse in Infants and Children. Eur J Pediatr Surg 2020; 30:401-405. [PMID: 32920799 DOI: 10.1055/s-0040-1716725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The surgical management of children with rectal prolapse is wide ranging and without consensus within the pediatric surgical community. While the majority of rectal prolapse in infants and children resolves spontaneously or with the medical management of constipation, a small but significant subset of patients may require intervention for persistent symptoms. In this review, we discuss the etiology and pathophysiology of rectal prolapse in both infants and children, options for medical management, described interventions and surgical options and their outcomes, and future avenues for research and investigation.
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Affiliation(s)
- Payam Saadai
- Department of Pediatric Surgery, UC Davis Children's Hospital, Sacramento, California, United States.,Department of Pediatric Surgery, Shriners Hospitals for Children Northern California, Sacramento, California, United States
| | - A Francois Trappey
- Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, United States
| | - Jacob L Langer
- Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Osuchukwu O, Dorman RM, Dekonenko C, Svetanoff WJ, Fraser JD, Aguayo P, St Peter SD, Oyetunji TA, Rentea RM. Same-Day Discharge and Quality of Life for Primary Laparoscopic Rectopexy for Rectal Prolapse in Children: A 10-Year Experience. J Laparoendosc Adv Surg Tech A 2020; 30:679-684. [PMID: 32315564 DOI: 10.1089/lap.2020.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction: Rectal prolapse (RP) in pediatric patients may require surgical intervention. Varying surgical approaches and heterogenous patient populations have resulted in difficulty defining surgical outcomes and superiority of technique. We sought to review our surgical and self-reported outcomes of patients who underwent laparoscopic rectopexy for idiopathic RP. Methods: Records of children <18 years who underwent primary laparoscopic rectopexy between March 2009 and March 2019 were retrospectively reviewed. Patients with redo rectopexy were excluded. Demographics, pre- and postoperative treatment, and outcome data were collected and reported using descriptive statistics. Qualitative analysis of a quality of life (QoL) questionnaire administered to patients and parents 2-10 years postoperatively was performed. Results: Fifteen patients were included. Median age at surgery was 5 years (interquartile range [IQR] 3, 12.5); 60% were male and median weight was 22 kg (IQR 16.4, 39.2). Median length of stay was 6 hours (IQR 4, 22) with 9 (60%) discharged the same day. Perioperatively, 73% were on laxative for constipation, whereas only 33% were on laxative therapy at 6 months postrectopexy. Median follow-up was 19 months (IQR 8, 39). Three patients (20%) suffered recurrent RP (2 required redo rectopexy), and 2 patients self-limited urinary retention. Respondents to the QoL questionnaire indicated improvement in symptoms after surgery. No patient reported fecal incontinence, smearing, or leakage of stool. Conclusion: Laparoscopic rectopexy is a safe minimally invasive approach for children with idiopathic RP that offers high patient satisfaction with same-day discharge, early recovery, and low recurrence.
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Affiliation(s)
- Obiyo Osuchukwu
- Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Robert M Dorman
- Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Charlene Dekonenko
- Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Wendy Jo Svetanoff
- Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Jason D Fraser
- Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, Missouri, USA.,Department of Sugery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, Missouri, USA.,Department of Sugery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, Missouri, USA.,Department of Sugery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, Missouri, USA.,Department of Sugery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, Missouri, USA.,Department of Sugery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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