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J Pediatr Surg. 2015 Feb;50(2):353-5. doi: 10.1016/j.jpedsurg.2014.09.081. Epub 2014 Dec 18.

Laparoscopic modified Orr-Loygue mesh rectopexy for rectal prolapse in children.

Author information

1
Department of Pediatric Surgery, H.U.S., Hautepierre Hospital, 67098 Strasbourg Cedex, France; Department of Pediatric Surgery, Kannerklinik, Centre Hospitalier De Luxembourg, Luxemburg City, Luxembourg.
2
Department of Pediatric Surgery, H.U.S., Hautepierre Hospital, 67098 Strasbourg Cedex, France.
3
Department of Pediatric Surgery, Kannerklinik, Centre Hospitalier De Luxembourg, Luxemburg City, Luxembourg.
4
Department of Pediatric Surgery, H.U.S., Hautepierre Hospital, 67098 Strasbourg Cedex, France. Electronic address: francois.becmeur@chru-strasbourg.fr.

Abstract

AIM:

We present an operating technique inspired from the Orr-Loygue mesh rectopexy adapted for laparoscopy, and detail the technical steps that differ from laparoscopic posterior suture rectopexy more commonly described in the paediatric literature.

METHOD:

We present a retrospective study of all children who underwent a modified Orr-Loygue procedure for recurrent complete rectal prolapse from 1999 to 2012 after failure of conservative treatment. Pathological conditions, technical details of the procedure (excision of the Douglas pouch, use of a prerectal non-absorbable mesh to suspend the rectum to the presacral fascia and promontory avoiding any tension on the rectal wall) and postoperative results were reviewed.

RESULTS:

Eight patients were included, median age 6.5 years (range, 2-17). Median symptoms duration before surgery was 14 months (range, 6-24). Four patients presented with associated pathological conditions: 1 neurological impairment (Williams-Beuren syndrome), 1 severe malnutrition (mental anorexia), 1 solitary rectal ulcer with frequent bleeding, 1 syringomyelic cavity in the spinal cord. All procedures were completed laparoscopically with a median operative time of 98 minutes (range, 80-125). Median hospital stay was 3.5 days (range, 2-5). No postoperative constipation or recurrence was reported during the median follow-up period of 6 years (range 2-13).

CONCLUSION:

The laparoscopic modified Orr-Loygue mesh rectopexy is a simple operating technique, reproducible and efficient as surgical treatment of nonresolving recurrent complete rectal prolapse in children. To avoid postoperative constipation, it is important to perform a tension-free rectopexy which can be achieved by the use of a mesh to simply suspend and not "fix" the redundant rectosigmoid. Nonetheless, a greater number of patients as well as colorectal electromyography or anorectal manometry would be necessary to prove the absence of postoperative deleterious functional disorder.

KEYWORDS:

Laparoscopy; Pediatrics; Rectal prolapse; Rectopexy

PMID:
25638636
DOI:
10.1016/j.jpedsurg.2014.09.081
[Indexed for MEDLINE]

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