title: Classification and management of rectal prolapse after anorectoplasty for anorectal malformations.
abstract: OBJECTIVE
  To suggest a classification, describe the risk factors and management of rectal prolapse after anorectoplasty for anorectal malformations (ARMs).
  
  
  METHODS
  We classified prolapse as minimal (rectal mucosa visible with Valsalva manoeuvre), moderate (prolapse <5 mm without Valsalva), evident (>5 mm without Valsalva) and compared patients with and without prolapse within our ARM-population.
  
  
  RESULTS
  Among 150 patients, 40 (27 %) developed prolapse: 25 minimal, 6 moderate, 9 evident. Prolapse affected 33 % of males (9 % of perineal fistulas, 38 % of bulbar, 71 % of prostatic, 60 % of bladder neck and 13 % without fistula) and 21 % of females (9 % of perineal, 30 % of vestibular, 50 % of cloacas, and 25 % without fistula). Risk factors for prolapse were: tethered cord (40 vs 24 %), vertebral anomalies (39 vs 24 %), laparoscopic-assisted anorectoplasty (LAARP) (75 vs 25 %), and colostomy at birth (49 vs 9 %). Redo anorectoplasty was not associated with prolapse. Symptoms were present in 11 patients (28 %): in 7 % with minimal, 33 % with moderate and 77 % with evident prolapse. Nine patients (2 moderate, 7 evident) underwent surgical correction.
  
  
  CONCLUSIONS
  Severe ARMs, tethered cord, vertebral anomalies, colostomy, and LAARP predispose to rectal prolapse. Classifying prolapse allows to predict symptoms and need for surgical correction, and to compare outcomes among different centers.
authors: Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Padiglione Alfieri, Via Commenda 10, 20122, Milano, Italy, giuliabrisighelli@gmail.com.
authors: Giulia
authors: G
authors: Brisighelli
authors: Antonio
authors: A
authors: Di Cesare
authors: Anna
authors: A
authors: Morandi
authors: Irene
authors: I
authors: Paraboschi
authors: Lorena
authors: L
authors: Canazza
authors: Dario
authors: D
authors: Consonni
authors: Ernesto
authors: E
authors: Leva
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery*; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000150:complications*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012005:Rectal Prolapse / Q000145:classification* / Q000209:etiology / Q000601:surgery; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome