TY - JOUR
T1 - Classification and management of rectal prolapse after anorectoplasty for anorectal malformations
AU - Brisighelli, Giulia
AU - Di Cesare, Antonio
AU - Morandi, Anna
AU - Paraboschi, Irene
AU - Canazza, Lorena
AU - Consonni, Dario
AU - Leva, Ernesto
PY - 2014
Y1 - 2014
N2 - Purpose: To suggest a classification, describe the risk factors and management of rectal prolapse after anorectoplasty for anorectal malformations (ARMs). Methods: We classified prolapse as minimal (rectal mucosa visible with Valsalva manoeuvre), moderate (prolapse 5 mm without Valsalva) and compared patients with and without prolapse within our ARM-population. Results: Among 150 patients, 40 (27 %) developed prolapse: 25 minimal, 6 moderate, 9 evident. Prolapse affected 33 % of males (9 % of perineal fistulas, 38 % of bulbar, 71 % of prostatic, 60 % of bladder neck and 13 % without fistula) and 21 % of females (9 % of perineal, 30 % of vestibular, 50 % of cloacas, and 25 % without fistula). Risk factors for prolapse were: tethered cord (40 vs 24 %), vertebral anomalies (39 vs 24 %), laparoscopic-assisted anorectoplasty (LAARP) (75 vs 25 %), and colostomy at birth (49 vs 9 %). Redo anorectoplasty was not associated with prolapse. Symptoms were present in 11 patients (28 %): in 7 % with minimal, 33 % with moderate and 77 % with evident prolapse. Nine patients (2 moderate, 7 evident) underwent surgical correction. Conclusion: Severe ARMs, tethered cord, vertebral anomalies, colostomy, and LAARP predispose to rectal prolapse. Classifying prolapse allows to predict symptoms and need for surgical correction, and to compare outcomes among different centers.
AB - Purpose: To suggest a classification, describe the risk factors and management of rectal prolapse after anorectoplasty for anorectal malformations (ARMs). Methods: We classified prolapse as minimal (rectal mucosa visible with Valsalva manoeuvre), moderate (prolapse 5 mm without Valsalva) and compared patients with and without prolapse within our ARM-population. Results: Among 150 patients, 40 (27 %) developed prolapse: 25 minimal, 6 moderate, 9 evident. Prolapse affected 33 % of males (9 % of perineal fistulas, 38 % of bulbar, 71 % of prostatic, 60 % of bladder neck and 13 % without fistula) and 21 % of females (9 % of perineal, 30 % of vestibular, 50 % of cloacas, and 25 % without fistula). Risk factors for prolapse were: tethered cord (40 vs 24 %), vertebral anomalies (39 vs 24 %), laparoscopic-assisted anorectoplasty (LAARP) (75 vs 25 %), and colostomy at birth (49 vs 9 %). Redo anorectoplasty was not associated with prolapse. Symptoms were present in 11 patients (28 %): in 7 % with minimal, 33 % with moderate and 77 % with evident prolapse. Nine patients (2 moderate, 7 evident) underwent surgical correction. Conclusion: Severe ARMs, tethered cord, vertebral anomalies, colostomy, and LAARP predispose to rectal prolapse. Classifying prolapse allows to predict symptoms and need for surgical correction, and to compare outcomes among different centers.
KW - Anoplasty
KW - Anorectal malformation
KW - Anorectoplasty
KW - PSARP
KW - Rectal prolapse
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U2 - 10.1007/s00383-014-3533-7
DO - 10.1007/s00383-014-3533-7
M3 - Article
C2 - 24969817
AN - SCOPUS:84908357035
VL - 30
SP - 783
EP - 789
JO - Pediatric Surgery International
JF - Pediatric Surgery International
SN - 0179-0358
IS - 8
ER -