POSTERIOR SAGITTAL ANORECTOPEXY FOR PAEDIATRIC RECTAL PROLAPSE

Introduction: Rectal prolapse is a very common and self limiting condition amongst the paediatric age group in India. Majority of the cases respond to conservative management. The various modalities of management of the same include surgical as well as medical modalities. Surgical namely Thierschs anal circlage, laparoscopic suture rectopexy, and posterior sagittal rectopexy Aim - To evaluate the safety and efcacy of posterior sagittal rectopexy in children with rectal prolapse. Patients and Methods: Twenty patients aged between 1 and 7 years presented with rectal prolapse. These patients underwent posterior sagittal anorectopexy after pre anaesthetic check up. These patients were followed up at 1week, 15days and 1month for 3 months. Results: Constipation improved in 18 out of 20 patients, who had a history of constipation before surgery. Partial mucosal prolapse recurrence occurred in two patients. Conclusion: Posterior Sagittal Rectopexy is a good option in cases of rectal prolapse in children once all the conservative methods have failed. The technique is safe and effective. It has satisfactory functional results.

Suture rectopexy versus ventral mesh rectopexy for complete full-thickness rectal prolapse and intussusception: systematic review and meta-analysis

Background This systematic review and meta-analysis aimed to compare recurrence rates of rectal prolapse following ventral mesh rectopexy (VMR) and suture rectopexy (SR). Methods MEDLINE, Embase, and the Cochrane Library were searched for studies reporting on the recurrence rates of complete rectal prolapse (CRP) or intussusception (IS) after SR and VMR. Results were pooled and procedures compared; a subgroup analysis was performed comparing patients with CRP and IS who underwent VMR using biological versus synthetic meshes. A meta-analysis of studies comparing SR and VMR was undertaken. The Methodological Items for Non-Randomized Studies score, the Newcastle–Ottawa Scale, and the Cochrane Collaboration tool were used to assess the quality of studies. Results Twenty-two studies with 976 patients were included in the SR group and 31 studies with 1605 patients in the VMR group; among these studies, five were eligible for meta-analysis. Overall, in patients with CRP, the recurrence rate was 8.6 per cent after SR and 3.7 per cent after VMR (P < 0.001). However, in patients with IS treated using VMR, the recurrence rate was 9.7 per cent. Recurrence rates after VMR did not differ with use of biological or synthetic mesh in patients treated for CRP (4.1 versus 3.6 per cent; P = 0.789) and or IS (11.4 versus 11.0 per cent; P = 0.902). Results from the meta-analysis showed high heterogeneity, and the difference in recurrence rates between SR and VMR groups was not statistically significant (P = 0.76). Conclusion Although the systematic review showed a higher recurrence rate after SR than VMR for treatment of CRP, this result was not confirmed by meta-analysis. Therefore, robust RCTs comparing SR and biological VMR are required.

A CLINICALANALYSIS OF THE OUTCOME OF CHIVATE'S PROCEDURE AND MILLIGAN-MORGAN PROCEDURE FOR HAEMORRHOIDS

Aim: To study the outcome of the Chivate’s transanal suture rectopexy with milligan morgan procedure in patients of haemorrhoids from clinical perspective. Methods: From April 2018 to September 2019,30 patients of haemorrhoids(grade III/ IV) were randomly assigned to undergo either the transanal suture rectopexy (n= 15) or Milligan Morgan procedure (n=15). Outcome assessment was performed at 12 hours,24 hours,3days,weekly once for 1 month,monthly once for 5months. Variables included Post-operative complications, resolution of symptoms. Results: Both the groups were comparable in terms of demographic data. Of the 15 patients who underwent Chivate’s procedure, none of the patients complained of Pain. 1pt had minimal bleeding intra-operatively. 3 pts had urinary retention and another 2 pts had transient anal incontinence to flatus. Mild mucous discharge per rectum noted in 1 patient. All the patients were discharged in 24hrs. Of the 15 patients who underwent Milligan-Morgan procedure, 10 patients complained of severe pain in the post-operative periods. Bleeding was seen intra operatively in 3 pts and urinary retention seen in 1 pt. Mild mucus discharge per rectum was seen in the early post-operative period in 1 pt. Most of the patients stayed under admission for 3-4days. There was difficulty in passing stools postop in 3patients, thus, requiring increased use of laxatives in these patients. None of the patients had residual pile masses or recurrence in this study after long term follow up. Conclusion: Transanal suture rectopexy certainly offers lower incidence of post-op morbidities and better patient compliance than milligan morgan open hemorrhoidectomy.

Laparoscopic Suture versus Mesh Rectopexy for the Treatment of Persistent Complete Rectal Prolapse in Children: A Comparative Randomized Study

Purpose. To compare laparoscopic mesh rectopexy with laparoscopic suture rectopexy. Patients and Methods. The prospective study was conducted at Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt between Feb 2010 and Jan 2015. Seventy-eight children with persistent complete rectal prolapse were subjected to laparoscopic rectopexy. Fourteen parents refused to participate. All patients received initial conservative treatment for more than one year. The remaining 64 patients were randomized divided into two equal groups. Group A; 32 patients underwent laparoscopic mesh rectopexy and group B, 32 underwent laparoscopic suture rectopexy. The operative time, recurrence rate, post-operative constipation, and effect on fecal incontinence, were reported and evaluated for each group. Results. Sixty-four cases presented with persistent complete rectal prolapse were the material of this study. They were 40 males and 24 females. Mean age at operation was 8 (5–12) years. All cases were completed laparoscopically. Mean operative time in laparoscopic suture rectopexy was shorter than laparoscopic mesh rectopexy group. No early post-operative complications were encountered. No cases of recurrence with mesh rectopexy group while in suture rectopexy group it was 4 cases (14.2%). Post-operative constipation occurred in one case (3.57%) in suture rectopexy group and occurred in one case (3.3%) in mesh rectopexy group. Fecal incontinence improved in 26/28 cases (92.8%) in suture rectopexy while in mesh rectopexy it was improved in 30/30 cases (100%) of cases. Conclusion. Both laparoscopic mesh and suture rectopexy are feasible and reliable methods for the treatment of complete rectal prolapse in children. However, no recurrence, low incidence of constipation and high improvement of incontinence at follow up more than 36 months with mesh rectopexy accordingly, we considered mesh rectopexy to be the procedure of choice in treatment of complete rectal prolapse.