Management of Rectal Prolapse in Children: Our Experience of Thiersch Stitch Procedure
Management of Rectal Prolapse in Children: Our Experience of Thiersch Stitch Procedure
Management of Rectal Prolapse in Children: Our Experience of Thiersch Stitch Procedure
ORIGINAL ARTICLE
ABSTRACT
Background: Rectal prolapse is a common pediatric surgical problem with many treatment options. This
study was conducted to assess the outcome of Thiersch stitch in the management of rectal prolapse in
children.
Methodology: It was a descriptive study conducted at Department of Pediatric Surgery, Lady Reading
Hospital Peshawar from January 2003 to December 2008. Patients with complete rectal prolapse for more
than 3 months were included. Patients were admitted 24 hours before the procedure. Kleen enema was
given in the morning of operation. The procedure was performed under general anaesthesia. Vicryl size 1
was wrapped around the lower part of anal canal subcutaneously. Patients were discharged home on same
day on oral analgesics for a week and laxatives for a month. They were followed in outpatient department for
3 months and any complication was recorded.
Results: Sixty-five patients, 37 males and 28 females, with complete rectal prolapse were operated. Age
range was 2-8 years. No complication was seen during operation. Post-operatively painful defecation was
observed in all patients, wound infection in 36, scanty bleeding and diaper staining in 25, constipation in 20
and recurrent rectal prolapse in 6 patients.
Conclusion: Surgical treatment of rectal prolapse by Thiersch stitch is simple to perform and has less
complications.
KEY WORDS: Rectal prolapse, Thiersch stitch, Children.
INTRODUCTION
Rectal prolapse is defined as the herniation
of rectum through the anus.1 It is subdivided into
partial and complete prolapse. The term Procedentia refers to the complete variety.2 Rectal prolapse usually occurs at extremes of age. It is most
common at 3 to 5 years of age.3 Parents often
provide history of a dark red mass protruding
from the childs anus and the child usually is pain
free.4
Idiopathic rectal prolapse is seen in otherwise normal children.5 In our part of the world children with malnourishment and diarrhea frequently
present with rectal prolapse of various intensity.6
This sequel of events can be explained by the fact
that in early age the child tries to learn the balanced act of defecation. It is percieved that the
condition will improve over the period of time as
the child is taught how to defecate.7
Children with conditions such as rectal polyps, worm infestation, proctitis, ulcerative colitis,
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RESULTS
A total of 65 patients with complete rectal
prolapse were operated during the study period.
Out of these 37 were males and 28 females. Age
range was 2 to 8 years.
Table 1: Age of patients at the time
of presentation.
S.
No
Age of patients
Number of patients
2-4 years
36
5-8 years
29
Complication
Number of
patients
Painful defecation
65
Wound infection
36
Diaper staining
25
Constipation
20
Recurrence of rectal
prolapse
DICUSSION
Rectal prolapse is a common problem in children. It is usually self-limiting.16 Different options of
treatment are available but none of them are optimal or standard in pediatric age group.17 Management of rectal prolapse starts with conservative
measures like treating constipation, avoiding excessive straining at defecation, avoiding squatting position during defecation, proper toilet training and eliminating any precipitating factors like
malnourishment, diarrhea, rectal polyp, etc.18 There
is no consensus regarding the most effective surgical procedure for rectal prolapse.18,19 The ideal
surgical procedure for correction of rectal prolapse remain unknown despite more than a hundred procedures described so far.10-21 These procedures include abdominal procedures, trans-sacral fixation, injection sclerotherapy using different
substances and perennial procedures. The selection of surgical procedure depends upon many
factors like age, fitness for general anesthesia and
the presence of any other associated problem. In
adults the most commonly used procedures used
are trans-abdominal approach or resection and
or fixation of rectum to the sacrum.22 In chidren
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5.
Antao B, Bradly V, Roberts JP, Shawis R, Management of rectal prolapse in children. Dis colon Rectum 2005; 48: 1620-5.
6.
Saifekas C, Vottler TP, Anderson JM. Rectal prolapse in pediatric. Clin pediatr (phila) 1999; 38:
63-72.
7.
8.
9.
10.
11.
12.
13.
14.
Khainga SO. Graciloplasty in treatment of recurrent complete rectal prolapse. East Afr Med
J 2007; 84: 398-400.
CONCLUSION
15.
16.
17.
18.
19.
REFERENCES
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Gourgiotis S, Baratsis S, Buhr HJ. Rectal prolapse. Int J colorectal Dis.2007; 22: 1561.
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Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg 2005;
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Bashir A, Roshan A. Management of rectal prolapse in children.. J Surg Pak 2009; 14: 116-9.
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Crlos WS, Desiderio RK, Sergio Cguilme C. Surgical treatment of rectal prolapse: experience
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Coresponding author:
Dr. Arshad Kamal
District Pediatric Surgeon
Mardan Medical Complex
Mardan, KPK, Pakistan
E-mail: [email protected]
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