Recurrent rectal prolapse following primary surgical treatment.

PURPOSE: The management of recurrent rectal prolapse following initial surgical procedures remains unclear. We present a series of pediatric patients with rectal prolapse and describe their surgical management, and the subsequent care for those children developing recurrence.

METHODS: The records of 29 pediatric patients with rectal prolapse refractory to conservative medical management who were managed with primary modified Thiersch procedures over a 14-year period were reviewed. Initial surgical management consisted of a modified version of the Thiersch anal encirclement procedure, which involved a combination of injection sclerotherapy, linear cauterization, and placement of a Thiersch anal encirclement absorbable stitch. Age at initial procedure, predisposing conditions, complications, recurrence, time to recurrence, and subsequent procedures utilized were reviewed.

RESULTS: Of 29 patients, 22 (71%) were male with a mean age at time of first Thiersch procedure of 7.1 years (range 3 months to 19 years). Seven patients were lost to follow-up. Nineteen patients (90%) experienced resolution of their prolapse following one or two modified Thiersch procedures; 14 (67%) following an initial Thiersch and 5 (23%) following a subsequent Thiersch. One additional child experienced recurrence after an initial Thiersch procedure, and underwent a perineal resection of redundant rectum (modified Altemeier procedure). Two patients developed a recurrence after their second Thiersch. These cases both required a modified Altemeier procedure. Mean follow-up for all patients was 1.5 years.

CONCLUSION: For pediatric rectal prolapse refractory to conservative medical therapy, the modified Thiersch procedure appears reasonable. Initial recurrences are not uncommon, and their incidence increases with the age of the child. Recurrences should be initially managed by a repeat Thiersch procedure. However, subsequent recurrences should be treated with a modified Altemeier.