Megan A. Read, Liese C.C. Pruitt, Brenna Rachwal, Kristine L. Griffina, Richard J. Wood, Alessandra C. Gasio
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.
Type: video · 0 min · posted 2025-09-04 Canonical: https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942 ## Chapters - [0:00](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=0) Rectal Prolapse Repair Morbidity After ARM Surgery ## Statements - "A study examined 85 children treated for rectal prolapse after anorectal malformation surgery" — Lizzie Lee (epidemiological) [0:11](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=11) - "Approximately 30% of children had recurrence of prolapse requiring another repair" — Lizzie Lee (epidemiological) [0:16](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=16) - "Children without symptoms from prolapse at initial presentation were more likely to develop stricture later" — Lizzie Lee (clinical) [0:20](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=20) - "Surgical repair of asymptomatic rectal prolapse may not be indicated because the treatment itself carries risks" — Lizzie Lee (opinion) [0:26](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=26) ## Transcript What if the safest move for rectal prolapse after anorectal malformation surgery is not to repair it? I'm Lizzie Lee from Cincinnati Children's, and this is an article you should know about. This new study looked at 85 children treated for rectal prolapse after anorectal malformation surgery. About 30% of them had the prolapse come back and needed another repair. And here's the thing, kids who didn't have symptoms from the prolapse at first were more likely to develop a stricture later. So the big takeaway, surgeons need to think twice before rushing into repair if the prolapse isn't causing big symptoms, because the treatment itself can carry risks. Let us know what you think in the comments below and stay tuned for more articles that you should know about. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai