Surgical treatment of rectal prolapse in pediatric patients: A single- center experience from Iran

Abstract

Introduction: Rectal prolapse refers to extrusion of mucosa or the full thickness wall of the rectum through the anal sphincter, which is more common between infancy and 4 years of age and has a high incidence in the first year of life. It is considered as a sign of an underlying clinical condition causing an increased intra‑abdominal pressure, pelvic floor weakness or poor root innervations as seen in Hirschsprung’s disease; and not a distinct entity. Also many different methods of surgery exist for treating this condition. We reviewed our experience with regard to treatment and outcome of rectal prolapse in a tertiary center. Materials and Methods: All patients with rectal prolapse who were managed at Mofid Children’s Hospital between 2005 and 2014 were evaluated. Clinical information was obtained from their hospital records. Main study variables were age and sex, the type of prolapse, clinical findings and type of surgery performed and complications. Results: Of a total 111 patients, 82 (73.9%) were boys and 29 (26.1%) were girls with a mean age of 3.5 yrs ± 2.3 SD at the time of diagnosis and a mean age of 4.3 yrs ± 3SD at the time of surgery. The most frequent type of rectal prolapse was mucosal. Conservative treatment mainly consisting of constipation therapy was carried out in 24.3% of our patients. The most common surgical procedures used in our center were Lockhart mummery and excision of the redundant mucosa (32.4%& 23.4% respectively). Performance of other methods depended on the attending surgeon’s preference. Almost 90% of our patients showed no post operative complications. In our study we had 9 cases with recurrent prolapse after surgery. The mean hospital stay was 3.9± 3.2 (ranging from 1 to 24 days). Conclusions: According to the obtained results, it could be concluded that treatment of rectal prolapse would result in improvement in nearly nine out of ten children and a low rate of postoperative complication are expected. However further studies should be performed to obtain more definite results.