Laparoscopic mesh rectopexy for complete rectal prolapse in children: a new simplified technique.
OBJECTIVE
Rectal prolapse in children without underlying conditions is usually a self-limiting problem and requires no surgical treatment. For children with persistent rectal prolapse, a variety of surgical procedures have been described with success. Recently, there are many reports addressing the successful use of different laparoscopic approaches for complete rectal prolapse. We present a novel simplified laparoscopic technique for management of those patients. The aim of this study is to evaluate the results that can be achieved by using this technique in management of persistent complete rectal prolapse in children.


METHODS
We reviewed the reports of 680 patients with primary complete and partial rectal prolapse over the period from August 2000 to August 2008. Fifty-two patients with complete primary rectal prolapse refractory to medical treatment for 2 years underwent a novel simplified technique for laparoscopic mesh rectopexy.


RESULTS
Conservative management was successful with no recurrences in 628 patients (92.4%) while 52 (7.6%) patients did not respond to conservative management at a median follow-up period of 2 years. They were 35 males and 17 females. Their ages ranged from 2 to 14 years (mean 6). All patients were subjected to laparoscopic mesh rectopexy successfully without any conversion. The mean duration of surgery was 40 min. No intraoperative complications were reported, but one patient developed postoperative constipation that responded well to conservative treatment. The mean postoperative hospitalization was 2 days. Two cases were lost to follow-up, while the others were available for 36 months. There was no recurrence.


CONCLUSIONS
Laparoscopy mesh rectopexy is safe, rapid, effective technique. It improved functional outcome without recurrence. It is associated with minimal postoperative pain and short hospital stay with excellent cosmoses.
General Surgery Department, Al-Azhar University, Cairo, Egypt. rafikshalaby@hotmail.com
Rafik
R
Shalaby
Maged
M
Ismail
Mohamad
M
Abdelaziz
Refaat
R
Ibrahem
Khaled
K
Hefny
Abdelaziz
A
Yehya
Abdelghany
A
Essa
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications; D012005:Rectal Prolapse / Q000601:surgery*; D013526:Surgical Mesh; D016896:Treatment Outcome