Assessment of outcomes of combined minimally invasive perineal procedures for treatment of complete rectal prolapse in children: an approach to reduce recurrence rate

Abstract

Background Rectal prolapse in children is common in developing countries with low health resources. Open and laparoscopic abdominal approaches are ideal for the treatment of rectal prolapse but they are not suitable for frail children and countries with poor medical resources. Perineal procedures are usually well tolerated and simple but have high recurrence rates. Objective Our objective is to assess the short-term outcomes of combined minimally invasive perineal procedures, including anal encirclement, submucosal alcohol injection, and Gant–Miwa procedure, in the management of full-thickness rectal prolapse in children. Through this combination, we looked forward toward magnifying the advantages of perineal procedures and allaying their complications, particularly recurrence rates. Patients and methods A total of 31 children with complete rectal prolapse were recruited during the period from May 2017 to June 2019. All the patients underwent three combined perineal procedures: mucosal plication (Gant’s technique), anal encirclement, and submucosal injection sclerotherapy. Results The study group included children with a median age of 6.55±2.14 years (range, 3.0–10.0 years). Mean operative time was 37.58±5.61 min (range, 30.0–45.0 min). The end results of our study were renovating anorectal physiology by correcting the rectal prolapse and improving continence (93.5%) and constipation (93.5%), with no mortality (0%) and low recurrence rates (3.2%). Conclusion Our approach (combined minimally invasive perineal procedures) is simple, effective, and less invasive, with minimal morbidity and a negligible recurrence rate, particularly for children with complete rectal prolapse.