Transsacral approach to repair of rectal prolapse in children.

Rectal prolapse is not uncommon in the pediatric age group. Occurring more frequently in boys than girls and most often during the period of toilet training, the condition is usually self-limited. Treatment typically consists of nonoperative measures. There are patients, however, in whom operative intervention becomes necessary. Operative procedures described are based largely on adult experience and the most common repairs involve the use of a foreign body (Ripstein procedure) or colonic resection. These procedures are of considerable magnitude and may be attended by significant morbidity. As a result, there is reluctance to apply these techniques in children. There exists, then, a place for an efficacious method of repair for large prolapses that incurs minimal morbidity. This report recounts our experience with the treatment of four children with rectal prolapse using a transsacral rectopexy. The results indicate minimal perioperative morbidity, discharge within a few days, with the mechanisms of fecal continence being preserved. The longest follow-up is 17 years with a mean follow-up of 9 years. The overall treatment of rectal prolapse in children is reviewed with specific emphasis upon the indications for and technique of the transsacral approach.