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

sitz bath, oral laxatives and anti-inflammatory drugs. on the bowel that may cause alteration of bowel motility
These data are similar to the results of other surgical and possible postoperative constipation. Laparoscopic
procedures including Ekehorn rectosacropexy, rectopexy and sigmoidopexy is favorable to mesh
modified Orr-Loygue mesh rectopexy, posterior repair fixation as it is a easier technique, has shorter operative
and suspension, sclerotherapy and transabdominal time, more cost-effective and without complications of
rectopexy with omental flap and laparoscopic mesh the mesh (e.g. pelvic abscess and rectal kink over the
rectopexy. They have reported excellent results with edge of the mesh causing constipation). In addition,
little morbidity. [7,10,11,18,20] laparoscopic rectopexy and sigmoidopexy showed
almost equal recurrence rate. [2,6,7,11,12,16]
Koivusalo et al. [17] had no recurrence in his cases who
underwent laparoscopic suture rectopexy (LSRP). If compared to suture rectopexy alone, laparoscopic
Also Puri [15] reported 1 case recurrence out of 19 rectopexy and sigmoidopexy has lower recurrence
cases during the follow-up for his cases. Rintala and rate, almost equal operative time, nearly similar
Pakarinen preferred laparoscopic rectal fixation to morbidities with less post-operative constipation. [6,12,17]
[1]
the anterior sacrum without using mesh, and they
claimed that this approach was successful in many In conclusion, we believe that our technique of
patients. In Ismail et al., [19] LSRP was done in 8 of 40 laparoscopic rectosigmoidopexy is an effective and
cases with excellent success rate and low morbidities efficient technique for treating children with persistent
and no recurrence. The recurrence rate in Awad et al. [6] full-thickness rectal prolapse having a low recurrence
using suture rectopexy was 1 case in 20 patients rate and minor complications. The anatomical
(5%). Randall et al. reported failure in all of his cases restoration of the normal rectosigmoid angle is
[2]
treated by laparoscopic suture rectopexy. The cause credited to our 3-point fixation concept. We propose
of failure in his series may be attributed to the fact that the new concept of 3-point fixation in the surgical
it was conducted on a different cohort of patients who treatment of persistent complete rectal prolapse as a
were older (median age at operation was 14 years). favorable alternative to other more complex open or
Potter et al. [12] reported also 1 case (5%) full thickness laparoscopic techniques with inevitably lower efficacy,
recurrence and mucosal prolapse in 2 cases (11%). higher morbidity and lower recurrence rates.

Correction of the prolapse also helped in controlling Authors’ contributions
the associated symptoms: bleeding completely Study conception and design, performing the surgical
disappeared, improvement of constipation was noticed technique: S. Shehata
during the outpatient visits and the postoperative Barium Critical revision and assistance in operations: M. Abouheba
enema showed no bowel dilation, no bowel kink and no Acquisition of data, drafting of manuscript: A. Mokhtar
residual dye indicating no delayed bowel emptying.
Financial support and sponsorship
As regards incontinence, it did not complicate any of our None.
cases preoperatively and was not encountered in our
cases postoperatively. The mean Kelly’s score [14] among Conflicts of interest
our cases was 5.58 indicating good continence. On the There are no conflicts of interest.
other hand, constipation, which was a major contributing
factor in our cases, improved postoperatively in cases Patient consent
presented with constipation and it did not complicate
any of our cases postoperatively. The mean Wexner/ Written detailed informed consent was obtained from
Agachan score [13] preoperatively was 17.3 (range 16- all parents.
19) which improved postoperatively to a mean of 6.83
(range 5-10). Koivusalo et al. [17] reported 2 patients with Ethics approval
postoperative constipation. Puri [15] reported 1 case with The protocol of work was approved by the ethical
postoperative constipation. Ismail et al. [19] reported 1 committee of our hospital.
case of postoperative constipation that was managed
conservatively. REFERENCES

Laparoscopic suture suspension of the rectum to the 1. Rintala RJ, Pakarinen M. Other disorders of the anus and rectum,
anorectal function. In: Grosfeld JL, O’Neill JA, Fonkalsrud EW,
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together with sigmoid fixation to add more support Elsevier; 2006. p. 1595-6.
preventing recurrence without exerting undue tension 2. Randall J, Gallagher H, Jaffray B. Laparoscopic rectopexy for external

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