The following is a summary of “Influence of Initial Treatment Strategy on Outcomes for Children With Rectal Prolapse,” published in the November 2023 issue of Pediatrics by Rincon-Cruz, et al.

For a study, researchers sought to assess the management strategies for pediatric rectal prolapse, a common yet challenging condition, by conducting a single-center retrospective review. The aim was to compare the outcomes of medical management, sclerotherapy, and surgical correction as initial treatment approaches, focusing on the resolution of prolapse.

Between 2010 and 2021, 67 children with rectal prolapse were retrospectively reviewed, excluding those with specific conditions. The study employed multivariable logistic regression to compare medical management, sclerotherapy, and surgical correction (rectopexy or transanal resection) as initial treatments. The primary endpoint was the resolution of prolapse.

The study found that younger patients, specifically those under the age of 5, were more inclined to receive initial treatment through medical management alone, and this association was statistically significant (P < 0.001). Moreover, patients with a psychiatric diagnosis were more likely to be presented with the option of either sclerotherapy or surgery as the primary approach, and this association reached statistical significance (P = 0.009). The study evaluated the resolution rates based on the initial management strategy. When surgery was chosen as the primary approach, the resolution rate reached 79% (11 out of 14 cases). In contrast, when sclerotherapy was the initial management, the resolution rate was 54% (13 out of 24 cases). Notably, among those who underwent sclerotherapy initially, 33% (8 out of 24) achieved resolution with sclerotherapy alone, while 21% (5 out of 24) achieved resolution after a subsequent surgical procedure. The difference in resolution rates between these groups was statistically significant (P = 0.011). Further analysis, considering adjusted odds ratios, revealed that patients who underwent initial surgical management had an odds ratio of 8.0 (95% CI: 1.1–59.1; P = 0.042) for the resolution of prolapse compared to those who underwent sclerotherapy initially. Additionally, markers of severity, such as bleeding or the need for manual reduction, did not show a significant association with the initial therapy offered (P = 0.064).

Surgical intervention, including rectopexy and transanal resection, effectively resolved rectal prolapse in the majority of children (63%). The study highlighted that surgery as the initial management approach demonstrated a significantly higher success rate than sclerotherapy, even after accounting for disease severity, psychiatric diagnosis, manual reduction necessity, and patient age.

Source: journals.lww.com/jpgn/abstract/2023/11000/influence_of_initial_treatment_strategy_on.8.aspx