Surgical management of pediatric rectal prolapse: A survey of the American Pediatric Surgical Association (APSA)

Alfred Francois Trappey, Laura Galganski, Payam Saadai, Jacob Stephenson, Rebecca Stark, Diana L Farmer, Jacob C. Langer, Shinjiro Hirose

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Introduction: Many management options exist for the treatment of refractory rectal prolapse (RP) in children. Our goal was to characterize current practice patterns among active members of APSA. Methods: A 23-item questionnaire assessed the management of full-thickness RP for healthy children who have failed medical management. The survey was approved by our IRB and by the APSA Outcomes committee. Results: 236 surgeons participated. The respondents were geographically dispersed (44 states, 5 provinces). 32% of respondents had twenty or more years of clinical experience. 71% evaluated 1–5 RP patients in the last 2 years, while 5% evaluated > 10. 71% performed 0–1 procedure (operation or local therapy [LT]) for RP over 2 years. 59% would treat a 2-year-old patient differently than a 6-year-old with the same presentation, and were more likely to offer up-front surgery to a 6-year-old (26% vs 15%, p = 0.04), less likely to continue medical management indefinitely (2% vs 7%, p = 0.01), and more likely to perform resection with rectopexy (30% vs. 15%, p = 0.01). 71% perform LT as an initial intervention: injection sclerotherapy (59%), anal encirclement (8%), and sclerotherapy + anal encirclement (5%). 70% consider LT a failure after 1–3 attempts. If LT fails, surgical management consists of transabdominal rectopexy (46%), perineal proctectomy or proctosigmoidectomy (22%), transabdominal sigmoidectomy + rectopexy (22%), and posterior sagittal rectopexy (9%). Conclusions: There is wide variability in the surgical management of pediatric rectal prolapse. This suggests a need for development of processes to identify best practices and optimize outcomes for this condition.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StatePublished - Jan 1 2019

Keywords

  • Constipation
  • Pediatric colorectal surgery
  • Pediatric rectal prolapse
  • Rectal prolapse
  • Rectopexy
  • Sclerotherapy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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