Morbidity of Rectal Prolapse Repair After Surgery for Anorectal Malformation

Abstract

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 of study: Retrospective Study.

Level of evidence: III.

Keywords: Anorectal malformation; Perianal stricture; Rectal prolapse.