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Surgical Management of Rectal Prolapse in Children: Injection Sclerotherapy, Thiersch Procedure or Both - Abstract

Kashif Chauhan, Omar Nasher, Richard WC Gan, Daniel W Colliver, Shailinder J Singh

 

Abstract

Aims: Rectal prolapse has two main first line surgical treatments: injection sclerotherapy and Thiersch suture. We have used a technique in which injection sclerotherapy is combined with Thiersch suture as first line treatment. This study compares results between two groups of patients: 1) injection treatment alone and 2) injection treatment combined with Thiersch suture.

Method: A retrospective single institution study on children diagnosed with full thickness rectal prolapse and managed surgically during a period of 5 years (October 2009 – July 2014) using known International Classification of Disease (ICD) code. Results are compiled using chi square test and p-value.

Results: A total of 26 patients (18 males, 8 females) were identified during the study period with a median age at diagnosis of 4 years (range 1-9). Clinical details of 25 patients were available. Two out of 25 had rectal mucosa prolapse so they are excluded. Rest of 23 patients had full thickness rectal prolapse and were analysed very carefully. Fourteen patients were treated with injection sclerotherapy alone, 8/14 (57.14 %) patients developed reoccurrence ranging from 1 month to 9 months post sclerotherapy injection. Among those 5/8 required further phenol injections, 1/8 required phenol and Thiersch suture, 1/7 required rectopexy and 1/8 required rectal mucosal excision. Nine patients were treated with injection sclerotherapy and Thiersch suture. One in 9 (11 %) had re-occurrence 3 months later and was successfully treated with repeated injection sclerotherapy and Thiersch suture. All the 23 patients were on laxatives post procedure and follow up was more than 18 months. The chi-square statistic is 4.1972 with p-value of 0.040491. This result is significant at p- value < 0.05.

Conclusion: Combination of injection sclerotherapy and Thiersch procedure is more effective than injection sclerotherapy alone in the treatment of full thickness rectal prolapse in children. A post-operative laxative regimen is required in these patients as they can develop de novo constipation in post-operative period.

Keywords: Thiersch procedure, rectal prolapse, injection sclerotherapy

 

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