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Mokhtar et al. Laparoscopic rectosigmoidopexy for intractable rectal prolapse in children

Table 1: Demographic data of the cases (n = 12) A
Age group Male, n (%) Female, n (%) Total, n (%)
< 3 years 0 (0) 6 (75) 6 (50)
3-6 years 2 (50) 2 (25) 4 (33.3)
6-9 years 2 (50) 0 (0) 2 (16.7)
Total 4 (33.3) 8 (66.7) 12 (100)
Mean ± SD 6.83 ± 2.93 1.98 ± 1.29
2016 was 65 cases: 15 cases (23.1%) who failed to
respond to conservative measures were admitted to
Alexandria Pediatric Surgery Department. Two of the
15 were at the age of 2 months and 1 case had huge
splenomegaly due to Gaucher disease and they were B
unfit for laparoscopic management, so were excluded
from the study. The remaining 12 cases underwent
laparoscopic rectopexy and sigmoidopexy [Table 1].

The mean age of presentation of our cases was 3.32
± 2.70 years, 8 (66.7%) females and 4 (33.3%) males
with a female to male ratio of 2:1. The median duration
of symptoms was 5.5 months.

All 12 cases (100%) were complaining of frequent “bowel
prolapse” of variable length ranged between 4 and 15
cm with a mean of 7.0 ± 3.02 cm, most frequently falling C
in the range of 5-7 cm, 8 of them (66.7%) presented
by persistent continuous prolapse that descends
immediately after reduction and 4 cases (33.3%)
presented by prolapse that occurs on straining and
after every defecation with mandatory manual reduction
from the start of their complaint. Bleeding per rectum
was a complaint in 4 cases (33.3%) only with prolapse.
Constipation was present in 3 cases (25%). The mean
Wexner/Agachan score [13] was 17.3 ± 1.52 (range 16-
19). Persistent straining was present in 6 cases (50%)
with or without constipation and 2 of which were known
ectopia vesicae patients and 1 case was complaining of Figure 5: (A) Barium enema postoperative (postero-anterior view);
urinary bladder stones. Solitary rectal ulcer was present (B) barium enema postoperative (lateral view); (C) barium enema
postoperative delayed film (postero-anterior view)
in 1 case (8.3%). Two cases had ectopia vesicae
(16.7%). Fecal incontinence was not encountered in in 1 case (8.3%). The recurrence occurred 1 week
any case. Four cases (33.3%) had previous Thiersch after the repair as a partial mucosal prolapse and was
procedure that failed 2 weeks to 1 month postoperatively managed conservatively. Bleeding resolved completely
and 1 case had undergone a repeat Thiersch. (100%) after correction of prolapse. Constipation neither
The mean operative time was 58.42 ± 22.75 min. recurred in the complaining cases nor complicated new
ones during the follow-up period. The mean Wexner/
There were no reported intraoperative complications. Agachan score [13] was 6.83 ± 1.64. Incontinence didn’t
All cases were completed laparoscopically without complicate any of our cases during the follow-up. The
conversion to open surgery. All patients achieved full mean Kelly’s score [14] was 5.58 ± 0.51 (range 5-6).
recovery, oral feeding started as soon as return of bowel Barium enema was done for all cases in our study 1
motion with mean hospital stay of 2.50 ± 0.52 days. month after surgery and showed no colonic dilatation
and no residual barium in their bowel [Figure 5].
The mean follow-up duration was 9.17 ± 3.86 months.
Postoperative complications were skin stitch sinus in DISCUSSION
1 case (8.3%) at the site of sigmoidopexy which was
treated by removing the stitch. Recurrence was reported Rectal prolapse is a common condition in children and
Mini-invasive Surgery ¦ Volume 1 ¦ March 31, 2017 27