WOFAPS 2025 8th World Congress of Pediatric Surgery

Igor Khvorostov ¹, Evgeniy Okulov ², Aleksey Dotsenko ², Aleksey Gusev ²

¹ Pirogov Russian National Research Medical University, Moscow, Russia
² National Medical Research Center for Children’s Health Federal state autonomous institution of the Russian Federation Ministry of Health, Moscow, Russia

Introduction. Rectal prolapse (rectal prolapse – RP) is one of the most expected complications after treatment of anorectal malformations, occurring with a frequency of 3.8% to 60%. The main method of surgical treatment of RP is anoplasty with a recurrence rate after surgery of up to 33%.

Objective: To evaluate the effectiveness of transanal rectal musculectomy and muscle implication (TMMP) surgery proposed by de la Torre for the treatment of RP in children with anorectal malformations (AM)

Methods The study was conducted with the approval of the Local Independent Ethics Committee at the Federal State Budgetary Educational Institution "NMIC of Children's Health" of the Ministry of Health of the Russian Federation (Protocol No. 2 dated 03.03.2022). The case histories of 234 patients who had previously undergone surgery for anorectal malformations were retrospectively analyzed. The average values of the studied quantitative parameters were described using the arithmetic mean (M), the standard deviation (SD), as well as the minimum (min) and maximum (max) values, the confidence interval (CI) and the representation of quartiles (Q1; Q3).

Results Circular RP was found in 63% (N=28), segmental in 37% (N=17). According to the form of AM, the patients were distributed as follows: rectourethral fistula 46.8%, AM without fistula 11.1%, perineal fistula 17.7%, vestibular fistula 15.5%, cloaca 4.4%, anal stenosis 2.2%, rectovaginal fistula 2.2%. Primary abdominal-perineal proctoplasty was performed in 37.7%, posterior sagittal anorectosphincteroplasty in 31.1%, laparoscopically assisted abdominal-perineal proctoplasty in 17.8% and anterior sagittal proctoplasty in 13.3%. 45 patients underwent the verified Delorme operation. The average age of patients at the time of surgery was 4.6 years (Q1 – 2.5, Q3 – 7.9; SD – 2.2; min/max – 2.0–5.0; 95% CI: 2.1–5.5). There were no postoperative complications. In all patients, the length of rectal prolapse averaged 2.3 cm (Q1 - 1.5, Q3 – 3.9; SD – 0.9; min/max – 1.6–4.0; 95% CI: 1.4–3.3). There were no RP recurrences and anastomotic stenoses during dynamic follow-up after surgery for 1.5 years (Q1 - 5.0, Q3 – 10.9; SD – 2.4; min/max – 5.0–11; 95% CI: 5.1–10.2)

Conclusion The advantage of the proposed technology can be considered its effectiveness in RP good cosmetic result, absence of complications in the form of anastomosis failure, stenosis and recurrence of RP.