Morbidity of Rectal Prolapse Repair After Surgery for Anorectal Malformation | 2014-2024 | single-institution review | retrospective | 1,275 patients | with anorectal malformation (ARM) | 85 underwent rectal prolapse repair | Median age at repair: 3 years | RECURRENCE: 30.6% required repeat prolapse repair | STRICTURES: 31.8% developed anal strictures | Ostomy/ostomy takedown: 1 recurrence risk (p=0.016) | Asymptomatic patients: Higher stricture risk (40.7% vs 16.1%, p=0.028) | Repair type: no significant difference in outcome | Conclusion: There are high rates of recurrence and stricture after prolapse repair in ARM patients. Asymptomatic patients face the greatest stricture risk and should be managed expectantly. | @LizzyPAC8 | @globalasiamd | @LizzyPAC8 | @StayCurrentMD | Cincinnati Children's | https://www.jpedsurg.org/article/S0022-3468(23)00252-X/abstract | Read MA et al. | Division of Pediatric Colorectal and Pelvic Reconstructive Surgery | Nationwide Children's Hospital, OH, USA | Journal of Pediatric Surgery
Morbidity of Rectal Prolapse Repair After Surgery for Anorectal Malformation
Infographic · Aug 2025 · 1 min read
In brief
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 repair in ARM patients carries 32% risk of postoperative stricture requiring intervention, most needing stricturoplasty.
- Asymptomatic prolapse patients have 2.5× higher stricture rate (41% vs 16%) — expectant management may be safer than prophylactic repair.
- 31% of patients experience recurrent prolapse requiring repeat surgery; presence of ostomy significantly increases recurrence risk.
- Surgical approach (partial vs complete circumferential repair) does not affect recurrence or stricture rates — technique choice flexible.
- Close postoperative monitoring essential: counsel all families on stricture risk and reserve surgery for symptomatic prolapse cases.
Written by the GCMD Library team from the infographic.
The infographic uses a teal header section with hospital icon and anatomical illustration, followed by green and gray sections highlighting key statistics. A cartoon surgeon illustration appears in the lower right. Color-coded text emphasizes recurrence (green), strictures (gray), and risk factors (burgundy and blue).
Megan A. Read, Liese C.C. Pruitta, Brenna Rachwala,Kristine L. Griffina, Richard J. Wood,∙ 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.