A Koivusalo1, M Pakarinen, R Rintala. 1. Hospital for Children and Adolescents, University of Helsinki, Helsinki, 000290, Finland. antti.koivusalo@hus.fi
Abstract
BACKGROUND: The repair of choice for persistent rectal prolapse (PRP) in children is disputed. Laparoscopic suture rectopexy (LSRP) is effective in adults, but its usefulness in pediatric PRP is unknown. We compared LSRP with posterosagittal rectopexy (PSRP). METHODS: Sixteen children, with a median age of 6.5 years (range, 0.8-16.8) and duration of symptoms of 2.8 years (range, 0.5-10.2), underwent surgery for PRP. Eight (1991-2000) had PSRP, and eight (2002-2005) had LSRP. Three patients with LSRP were healthy; the others had mental retardation and epilepsy (n = 1), cerebral palsy (n = 1), Aspeger's syndrome (n = 1), meningomyelocele (n = 1), and bladder extrophy (n = 1). Preoperative cologram (n = 6), sigmoideoscopy (n = 3), and anorectal manometry (n = 2) were normal in patients with LSRP. In LSRP, the rectum was mobilized and sutured to the sacral periosteum. RESULTS: Median operation time for LSRP was 80 min (range, 62-90) and for PSRP 40 min (range, 25-70) (p < 0.05); median hospital time was 6 days (range, 3-8) for LSRP and 6 days (range, 3-9) for PSRP (not significant). Six patients with LSRP had a median follow-up of 13 months (range, 4-24). None have had recurrences, and two patients (33%) require laxatives. Of the patients with PSRP, two (25%) had recurrence and underwent abdominal rectopexy with sigmoid resection. CONCLUSION: Medium-term results indicate that LSPR is effective in pediatric PRP. Constipation is the only postoperative problem in a significant proportion of patients.
BACKGROUND: The repair of choice for persistent rectal prolapse (PRP) in children is disputed. Laparoscopic suture rectopexy (LSRP) is effective in adults, but its usefulness in pediatric PRP is unknown. We compared LSRP with posterosagittal rectopexy (PSRP). METHODS: Sixteen children, with a median age of 6.5 years (range, 0.8-16.8) and duration of symptoms of 2.8 years (range, 0.5-10.2), underwent surgery for PRP. Eight (1991-2000) had PSRP, and eight (2002-2005) had LSRP. Three patients with LSRP were healthy; the others had mental retardation and epilepsy (n = 1), cerebral palsy (n = 1), Aspeger's syndrome (n = 1), meningomyelocele (n = 1), and bladder extrophy (n = 1). Preoperative cologram (n = 6), sigmoideoscopy (n = 3), and anorectal manometry (n = 2) were normal in patients with LSRP. In LSRP, the rectum was mobilized and sutured to the sacral periosteum. RESULTS: Median operation time for LSRP was 80 min (range, 62-90) and for PSRP 40 min (range, 25-70) (p < 0.05); median hospital time was 6 days (range, 3-8) for LSRP and 6 days (range, 3-9) for PSRP (not significant). Six patients with LSRP had a median follow-up of 13 months (range, 4-24). None have had recurrences, and two patients (33%) require laxatives. Of the patients with PSRP, two (25%) had recurrence and underwent abdominal rectopexy with sigmoid resection. CONCLUSION: Medium-term results indicate that LSPR is effective in pediatric PRP. Constipation is the only postoperative problem in a significant proportion of patients.
Authors: J Rose; C Schneider; H Scheidbach; C Yildirim; H P Bruch; J Konradt; E Bärlehner; F Köckerling Journal: Langenbecks Arch Surg Date: 2002-07-18 Impact factor: 3.445