a_clinical_pearl Regarding management of rectal prolapse

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Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay -

"Children presenting RP and older than 4 years usually have a predisposing condition. These older patients usually present recurrent or persistent RP and tend to require surgical repair more often, while RP is usually a self-limiting condition that resolves spontaneously in younger patients [2]."

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Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay -

"The diagnosis of RP is mostly clinical. RP should be considered a symptom of an underlying condition rather than a distinct disease entity. The preoperative workout has to search for a possible underlying condition that may predispose to RP. The paediatrician should start a conservative treatment directed by the associated condition before referring to the surgical team"

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Quotes from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay -

"Constipation is the most common associated diagnosis with RP in developed countries [1]."

"In developing countries, malnutrition and parasitic and diarrheal diseases are the most common risk factors for RP"

"it is nowadays recommended to do a sweat chloride test in patients with recurrent RP or without an identifiable underlying condition [2]."

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Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay -

"If RP is persistent despite a well-conducted medical treatment for at least 6 months, surgical treatment should be considered. In older cooperative patients, dynamic defecography is very useful and advisable before surgery to help identify evacuatory pelvic floor disorders (measurement of the anorectal angle, presence of rectocele or enterocele, sigmoid intussusception) [3]."

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Quotes from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay -

"the operative procedures are classified as “less invasive”, including injection sclerotherapy, anal encircling (Thiersch procedure), transanal suture rectosacropexy (Ekhorn’s procedure) and “more invasive” abdominal or perineal procedures. Perineal operations (Delorme’s procedure, perineal rectosigmoidectomy or Altemeier’s procedure, stapled transanal rectal resection) are rarely described in children. In adults, perineal procedures are associated with higher recurrence rate [16, 17]. Abdominal surgery involves rectal dissection and fixation aiming to reduce RP. Several techniques or fixation variations are in use."

"laparoscopic suture rectopexy (LSR), laparoscopic posterior mesh rectopexy (LPMR) and laparoscopic ventral mesh rectopexy (LVMR). All three procedures start with evaluation of the local anatomy: assessment of the redundancy of the rectosigmoid colon, evaluation of the deepness of the Douglas pouch and assessment of the laxity of the pelvic floor [12, 13, 15]."