Outcomes of Rectopexy of Rectal Prolapse through Anus by Sub Mucosal Injection of 5% Dextrose

Document Type : Research Paper

Authors

1 assistant professor of pediatric surgery,mashhad university of medical science, Mashhad, Iran

2 Associated professor of pediatric surgery,mashhad university of medical science, Mashhad, Iran

3 resident of general surgery, mashhad university of medical science, Mashhad, Iran

4 associated professor of anesthesiology,mashhad university of medical science, Mashhad, Iran

5 assistant professor of anesthesiology,mashhad university of medical science, Mashhad, Iran

Abstract

Introduction
Considering the vast methods of rectal prolapsed, a very common condition in children, either surgical (by abdominal or perineal approach) or non-surgical (sclerozing agents’ injection), the authors evaluated the therapeutic effects of injecting dextrose 50% through perineal rectopexy.
Materials and Methods
All those referred patients with rectal prolaps to Dr. sheikh children hospital were included in this study. All were sub-mucusally injected 5 cc of dextrose 50% solution and the therapeutic results (recurrence and complications) were evaluated.
Results
During this study 46 patients were injected about 5 cc of dextrose 50% solution. All went through the operation without any complications and during a 6 month following up none of the complications such as fistulae, abscess formation, urinary retention, and mucosal necrosis were detected. Nine patients were re-injected due to the prolapsed recurrence however no complications occurred in the second operation. The described procedure is a simple, inexpensive, and repeatable one.
Conclusion
Deflux has been suggested as the best sclorizing agent in articles but it is expensive. Sub-mucusally injection of dextrose 50% is a simple, inexpensive, and repeatable procedure with a 100% positive therapeutic results, therefore could be, suggested as a substitution procedure in treating children’s rectal prolapsed.

Keywords


1- Maron DJ, Nelson RL. Rectal Prolapse or Procidentia. In:O'Neill JA, Grosfeld JL, Fonkalsrud ED, Coran AG
,editors.. Principles of Pediatric Surgery. 2nd ed .New York: McGRAW-HILL;2004.p.1995-1996.
2- Antao B, Bradley V, Roberts JP, Shawis R. Management of rectal prolapse in children. Dis Colon Rectum 2005;
48:1620-1625.
3- Zempsky WT, Rosenstein BJ. The cause of rectal prolapse in children. Am J Dis Child 1988; 142:338-339.
4- Severijnen R, Festen C, van der Staak F, Rieu P. Rectal prolapse in children. Neth J Surg 1989; 41:149-151.
5- Siafakas C, Vottler TP, Andersen JM. Rectal prolapse in pediatrics. Clin Pediatr 1999; 38:63-72.
6- Fahmy MA, Ezzelarab S. Outcome of submucosal injection of different sclerosing material for rectal prolapse in
children. Pediatr Surg Int 2004; 20:353-6. Epub 2004 May 28.
7- Shah A, Parikh D, Jawaheer G, Gornall P.Persistent rectal prolapse in children: sclerotherapy and surgical
management. Pediatr Surg Int 2005; 21:270-3. Epub 2005 Mar 11.
8- Abes M, Sarihan H. Injection sclerotherapy of rectal prolapse in children with 15 percent salin solution. Eur Pediatr
Surg 2004; 14:100-102.
9- Chanw K, Kay SM, Laberge M, Gallucci G, Bensoussum AL, Yazbeck S. Injection sclerotherapy in the treatment of
rectal prolapse in infant and children. J Pediatr Surg 1998; 33:255-258.
10- Zganjer M, Cizmic A, Cigit I, Zupancic B, Bumci I, Popovic L, et al. Treatment of rectal prolapse in children with
cow milk injection sclerotherapy: 30-year experience. World J Gastroenterol 2008; 14:737-740.
11-Gysler R, Morger R. Sclerosing treatment with ethoxysclerol in anal prolapse in children. Z Kinderch 1989; 44:304-
305.
12-Bullard KM. Colon,rectom,and anus. In: Brunicardi Ch F, Andersen D K Billiar TR, Dunn D L, Hunter J G, Pollock
RE,editors. Schwartz,s Principles of Surgery.9th ed. New York: McGRAW-HILL;2010.p.1054.
13- Mann CV.Rectal Prolapse or Procidentia. In: Marvin CL,Editors.Colon and Rectal Surgery.5thed.NEW York:
Lippincott Williams & Wilkins;2005.p.238-499.
14-Tou S, Brown SR, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database Syst
Rev 2008;4:CD001758.
15-Lowney JK, Fleshman Jr JW. Benign Disorders of the Anorectum.In: Zinner M J, Ashley SW, editors. Maingot's
Abdominal Operations.11 th ed. NewYork:McGRAW-HILL;2007.p.669-672.
16-Heah SM, Hartley JE, Hurley J, Duthie GS, Monson JR. Laparoscopic suture rectopexy without resection is
effective treatment for full-thickness rectal prolapse. Dis Colon Rectum 2000; 43:638-643.
17-Fry R D, Mahmoud N, Maron DJ,Ross M,Rombeau J.Colon and Rectum.In: Courtney Jr MT ,editors. Sabiston
Textbook of Surgery.18th ed. Philadelphia: Sunders; 2007.p.1467-1472.
18- Habr-Gama A, Jacob CE, Jorge JM, Seid VE, Marques CF, Mantese JC, et al. Rectal procidentia treatment by
perineal rectosigmoidectomy combined with levator ani repair. Hepatogastroenterology 2006; 53:213-217.
19- Flum AS, Golladay ES, Teitelbaum DH. Recurrent rectal prolapse following primary surgical treatment. Pediatr
Surg Int 2010; 26:427-431.
20- Ismail M, Gabr K, Shalaby R. Laparoscopic management of persistent complete rectal prolapse in children. J
Pediatr Surg 2010; 45:533-539.
21- Gourgiotis S, Baratsis S. Rectal prolapse. Int J Colorectal Dis 2007; 22:231-243.