title: Laparoscopic modified Orr-Loygue mesh rectopexy for rectal prolapse in children.
abstract: OBJECTIVE
  We present an operating technique inspired from the Orr-Loygue mesh rectopexy adapted for laparoscopy, and detail the technical steps that differ from laparoscopic posterior suture rectopexy more commonly described in the paediatric literature.
  
  
  METHODS
  We present a retrospective study of all children who underwent a modified Orr-Loygue procedure for recurrent complete rectal prolapse from 1999 to 2012 after failure of conservative treatment. Pathological conditions, technical details of the procedure (excision of the Douglas pouch, use of a prerectal non-absorbable mesh to suspend the rectum to the presacral fascia and promontory avoiding any tension on the rectal wall) and postoperative results were reviewed.
  
  
  RESULTS
  Eight patients were included, median age 6.5 years (range, 2-17). Median symptoms duration before surgery was 14 months (range, 6-24). Four patients presented with associated pathological conditions: 1 neurological impairment (Williams-Beuren syndrome), 1 severe malnutrition (mental anorexia), 1 solitary rectal ulcer with frequent bleeding, 1 syringomyelic cavity in the spinal cord. All procedures were completed laparoscopically with a median operative time of 98 minutes (range, 80-125). Median hospital stay was 3.5 days (range, 2-5). No postoperative constipation or recurrence was reported during the median follow-up period of 6 years (range 2-13).
  
  
  CONCLUSIONS
  The laparoscopic modified Orr-Loygue mesh rectopexy is a simple operating technique, reproducible and efficient as surgical treatment of nonresolving recurrent complete rectal prolapse in children. To avoid postoperative constipation, it is important to perform a tension-free rectopexy which can be achieved by the use of a mesh to simply suspend and not "fix" the redundant rectosigmoid. Nonetheless, a greater number of patients as well as colorectal electromyography or anorectal manometry would be necessary to prove the absence of postoperative deleterious functional disorder.
authors: Department of Pediatric Surgery, H.U.S., Hautepierre Hospital, 67098 Strasbourg Cedex, France; Department of Pediatric Surgery, Kannerklinik, Centre Hospitalier De Luxembourg, Luxemburg City, Luxembourg.
authors: Cindy
authors: C
authors: Gomes-Ferreira
authors: Department of Pediatric Surgery, H.U.S., Hautepierre Hospital, 67098 Strasbourg Cedex, France.
authors: Anne
authors: A
authors: Schneider
authors: Department of Pediatric Surgery, Kannerklinik, Centre Hospitalier De Luxembourg, Luxemburg City, Luxembourg.
authors: Paul
authors: P
authors: Philippe
authors: Department of Pediatric Surgery, H.U.S., Hautepierre Hospital, 67098 Strasbourg Cedex, France.
authors: Isabelle
authors: I
authors: Lacreuse
authors: Department of Pediatric Surgery, H.U.S., Hautepierre Hospital, 67098 Strasbourg Cedex, France. Electronic address: francois.becmeur@chru-strasbourg.fr.
authors: Francois
authors: F
authors: Becmeur
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011474:Prosthesis Design; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Laparoscopy; Pediatrics; Rectal prolapse; Rectopexy