Morbidity of Rectal Prolapse Repair After Surgery for Anorectal Malformation

Infographic · Aug 2025 · 1 min read

In brief

Retrospective study of 85 patients with repaired anorectal malformations who underwent rectal prolapse repair found 31% recurrence and 32% developed postoperative stricture. Asymptomatic patients had significantly higher stricture rates (41% vs 16%), suggesting expectant management may be preferable for this group.

Rectal prolapse after ARM repair has 31% recurrence rate and 32% stricture rate, requiring close postoperative monitoring.
Asymptomatic prolapse patients have 2.5x higher stricture risk (41% vs 16%) and should be managed expectantly, not surgically.
Simultaneous ostomy takedown with prolapse repair significantly increases recurrence risk and should be avoided when possible.
Most post-repair strictures (89%) require Heineke-Mikulicz stricturoplasty for definitive management.
Surgical approach (partial vs complete circumferential repair) does not affect recurrence or stricture rates.

Written by the GCMD Library team from the infographic.

The infographic uses a teal header, green and white content sections, and yellow footer. It includes a hospital building icon, an anatomical illustration of anorectal anatomy in pink, and a cartoon surgeon character. Key statistics are displayed in large text with bullet points organizing findings.

Megan A. Reada, Liese C.C. Pruitta, Brenna Rachwala, Kristine L. Griffina, Richard J. Wooda, Alessandra C. Gasior

Purpose

Rectal prolapse is a known complication of surgery for anorectal malformations (ARM), however morbidity of prolapse repair and long-term outcomes are not well-described.

Methods

We performed a single-institution retrospective review of patients who underwent surgery for ARM then were treated for rectal prolapse at our institution from 2014 to 2024. Demographics, clinical characteristics, and surgical outcomes were assessed, and compared using Chi-squared or Fisher's exact testing.

Results

Of the 1275 patients with ARM treated at our institution during this period, 85 patients with previously repaired ARM underwent rectal prolapse repair (54 males, 63.53 %). Median age at initial surgery for rectal prolapse was 3 years (IQR 1.25–6.50). Median follow-up duration was 4 years (IQR 1.50–6.00). Recurrent prolapse requiring repeat repair occurred in 26 patients (30.59 %). Clinically significant post-operative stricture was identified in 27 patients (31.76 %), of whom 24 underwent Heineke-Mikulicz stricturoplasty (88.89 %). Patients who developed stricture were significantly more likely to have been asymptomatic from their prolapse on initial presentation compared to patients who did not develop stricture (N = 22, 81.48 % vs N = 32, 55.17 %, p = 0.028). Asymptomatic patients had a stricture rate of 40.74 %, as compared to 16.13 % for symptomatic patients. The presence of an ostomy and undergoing simultaneous ostomy takedown with prolapse repair was significantly associated with recurrent prolapse (p = 0.016), but not post-operative stricture formation (p = 0.769). There was no difference in rates of prolapse recurrence (p = 0.086) or anal stricture formation (p = 0.757) between patients who underwent partial, complete circumferential, or planned two-stage repair of a circumferential prolapse.

Conclusion

Morbidity from post-operative stricture is not an insignificant concern after prolapse repair, and merits close monitoring and follow-up. Judicious patient selection is critical to minimizing morbidity – we propose that asymptomatic patients should be treated expectantly, and that all patients be counseled on the risk of post-operative stricture.

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