Eur J Pediatr Surg 2010; 20(5): 321-324
DOI: 10.1055/s-0030-1254121
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Perineal Mesh Rectopexy with Sterile Talc in Children with Rectal Prolapse

M. Nazem1 , M. Hosseinpour2 , M. Farhadi3
  • 1Al-Zahra Hospital, Department of Pediatric Surgery, Isfahan, Islamic Republic of Iran
  • 2Trauma Research Center, KAUMS, Pediatric Surgery, Kashan, Islamic Republic of Iran
  • 3Trauma Research Center, KAUMS, General Surgery, Kashan, Islamic Republic of Iran
Weitere Informationen

Publikationsverlauf

received December 24, 2009

accepted after revision April 05, 2010

Publikationsdatum:
07. Juni 2010 (online)

Abstract

Background: With such a wide variety of treatment options available for rectal prolapse and a variable success rate, the optimal treatment for this condition in children is still debated. In this study, we evaluated a technique of perineal mesh rectopexy with a sterile talc-soaked mesh and compared the success rates and complications of this method with those of abdominal rectopexy.

Methods and materials: To examine the effect of therapeutic interventions, a randomized control trial (children were randomized into the case group or the control group) was carried out. In the control group, children were operated on by abdominal posterior mesh rectopexy. In the case group, a 30-cm sterile asbestos-free talc-soaked mesh was placed in the presacral space in a spiral fashion with the end exiting from the perineal incision. From 5th day after surgery onward, the mesh was gradually extracted (10 cm per day) and completely removed by the 7th postoperative day. On postoperative assessment, the duration of hospitalization, the postoperative complications and the success rates after surgery were compared. Patients were followed up for one year.

Results: In this study we evaluated 120 children. Mean age of the patients was 5.1±0.081 years in the case group and 4.91±0.59 years in the control group (p=NS). 34 patients in the case group were male vs. 41 patients in the control group. Results indicated that there was no statistically significant difference in postoperative complications between groups. The infection rate was 1.6% in the case group and 6.6% in the control group (p=NS).There was a higher resolution of constipation in the perineal rectopexy group (68.4% in the control group and 96.8% in the case group; p=0.002). The duration of hospitalization was 6.34±0.28 days in the case group and 6.68±0.31 days in the control group (p=NS).

Conclusion: Our findings suggest that perineal mesh rectopexy with sterile talc can be an alternative approach to abdominal surgery and offers an acceptable outcome with a low rate of complications.

References

  • 1 Qvist N, Rasmussen L, Klaaborg K. et al . Rectal prolapse in infancy: Conservative versus operative treatment.  J Pediatr Surg. 1986;  21 (10) 887-888
  • 2 Hetzer FH, Bieler A, Hahnloser D. Outcome and cost analysis of sacral nerve stimulation for fecal incontinence.  Br J Surg. 2006;  93 (11) 1411-1417
  • 3 Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse.  Arch Surg. 2005;  140 (1) 63-73
  • 4 Kellokumpu IH, Virozen J, Scheinin T. Laparoscopic repair of rectal prolapse: a prospective study evaluating surgical outcome and changes in symptoms and bowel function.  Surg Endosc. 2000;  14 (7) 634-640
  • 5 Watts AM, Thompson MR. Evaluation of Delorme's procedure as a treatment for full-thickness rectal prolapse.  Br J Surg. 2000;  87 (2) 218-222
  • 6 Lieberth M, Kondylis LA, Reilly JC. et al . The Delorme repair for full-thickness rectal prolapse: a retrospective review.  Am J Surg. 2009;  197 (3) 418-423
  • 7 Kairaluoma MV, Kellokumpu IH. Epidemiologic aspects of complete rectal prolapse.  Scand J Surg. 2005;  94 207-210
  • 8 Poen AC, Felt-Bersma RJ. Laparoscopic rectopexy for complete rectal prolapse: clinical outcome and anorectal function tests.  Surg Endosc. 1996;  10 (9) 904-908
  • 9 Keith W, Ashcraf M, Thomas M. et al .Acquired anorectal disorders.. In: Ashcraf M, Holder M. Pediatric Surgery. WB Saunders: Philadelphia; 1993: pp. 411-413
  • 10 Hollinger MA. Pulmonary toxicity of inhaled and intravenous talc.  Toxicol Lett. 1990;  52 (2) 121-127
  • 11 Harlow BL, Cramer DW, Bell DA. et al . Perineal exposure to talc and ovarian cancer risk.  Obstetrics and Gynecology. 1992;  80 (1) 19-26
  • 12 Scaglia M, Fasth S, Hallgren T. Abdominal rectopexy for rectal prolapse: influence of surgical technique on functional outcome.  Dis Colon Rectum. 1994;  37 (8) 805-813
  • 13 Yim AP, Chan AT, Lee TW. Thorascopic talc insufflation versus talc slurry for symptomatic malignant pleural effusion.  Ann Thorac Surg. 1996;  62 1655-1658
  • 14 Ong KC, Indumathi V, Raghuram J. et al . A comparative study of pleurodesis using talc slurry and bleomycin in the management of malignant pleural effusions.  Respirology. 2000;  5 (2) 99-103
  • 15 Horan TC, Gaynes RP, Martone WJ. et al . CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections.  Am J Infect Control. 1992;  20 271-274
  • 16 Van Heest R, Jones S, Giacomantonio M. Rectal prolapse in autistic children.  J Pediatr Surg. 2004;  39 (4) 643-644
  • 17 Ratan SK, Rattan KN, Jhajhria P. et al . The surged faradic stimulation to the pelvic floor muscles as an adjunct to the medical management in children with rectal prolapse.  BMC Pediatr. 2009;  9 44
  • 18 Antao B, Bradley V, Robets JP. et al . Management of rectal prolapse in children.  Dis Col Rectum. 2005;  48 (8) 1620-1625
  • 19 Chanab WK, Kayab SM, Laberge JM. et al . Sclerotherapy in the treatment of rectal prolapse in infants and children.  1998;  33 (2) 255-258
  • 20 Koivusalo A, Pakarinem M, Rintala R. Laparoscopic suture rectopexy in the treatment of persisting rectal prolapse in children: A preliminary report.  Surgical Endoscopy. 2006;  20 (6) 960-963
  • 21 Madoff R, Mellgren A. One hundred years of rectal prolapse surgery.  Dis Col Rectum. 1999;  42 (4) 441-450
  • 22 Pescatori M, Zbar A. Tailored surgery for internal and external rectal prolapse: functional results of 268 patients operated upon by a single surgeon over a 21-year period.  Colorectal Disease. 2009;  11 (4) 410-419
  • 23 Friedman R, Muggia-Sulam M, Freund HR. Experience with the one-stage perineal repair of rectal prolapsed.  Dis Col Rectum. 1983;  26 (2) 789-791
  • 24 CFSAN/Office of Food Additive Safety (July 2006). “Food Additive Status List”. U.S. Food and Drug Administration http://www.fda.gov/Food/FoodIngredientsPackaging/FoodAdditives/FoodAdditiveListings/ucm091048.htm#ftnT
  • 25 Dulucq JL, Wintringer P, Mahajna A. Clinical and functional outcome of laparoscopic posterior rectopexy (Wells) for full-thickness rectal prolapse. A prospective study.  Surg Endosc. 2007;  21 (12) 2226-2230
  • 26 Parks AG, Swash M, Ulrich H. Sphincter denervation in anorectal incontinence and rectal prolapse.  Gut. 1977;  18 656-659
  • 27 Farouk R, Duthie GS, MacGregor AB. et al . Rectoanal inhibition and incontinence in patients with rectal prolapse.  Br J Surg. 1994;  81 743-746
  • 28 Siproudhis L, Bellissant E, Juguet F. Rectal adaptation to distension in patients with overt rectal prolapse.  Br J Surg. 1998;  85 1527-1532
  • 29 Farouk R, Duthie GS, Bartolo DCC. et al . Restoration of continence following rectopexy and recovery of the internal anal sphincter electromyogram.  Br J Surg. 1992;  79 439-440
  • 30 Kim DS, Tsang CB, Wong WD. Complete rectal prolapse: evolution of management and results.  Dis Col Rectum. 1999;  42 460-466
  • 31 Jacobs LK, Lin YJ, Orkin BA. The best operation for rectal prolapse.  Surg Clin North Am. 1997;  77 49-70
  • 32 Fahmy MA, Ezzelarab S. Outcome of submucosal injection of different sclerosing materials for rectal prolapse in children.  Pediatr Surg Int. 2004;  20 353-356
  • 33 Sander S, Vural O, Uènal M. Management of rectal prolapse in children: Ekehorn's rectosacropexy.  Pediatr Surg Int. 1999;  15 111-114

Correspondence

Dr. Mehrdad Hosseinpour

Trauma Research Center

Shahid Beheshti Hospital

KAUMS

87159/81151 Kashan

Islamic Republic of Iran

Telefon: +98 311 6255 368

Fax: +98 361 5558 900

eMail: meh_hosseinpour@yahoo.com