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.

Pediatric rectal prolapse is a common disease that usually goes away independently. There are several ways to treat it. Personalization was needed to choose the best method, which is still hard for pediatricians and pediatric surgeons. For a study, researchers looked back at 67 children with rectal prolapse who had surgery between 2010 and 2021 at a single center. People who had Hirschsprung disease, inflammatory gut disease, anorectal malformations, or cystic fibrosis were not allowed to participate. They used multivariable logistic regression to examine how medical care, sclerotherapy, and surgery affected the resolution of prolapse as first-line treatments.

Patients younger than 5 years old were more likely to be handled with medical care alone at first (P < 0.001). People with mental illness were more likely to be offered surgery or sclerotherapy right away (P = 0.009). When surgery was the first treatment, in 79% of cases (n = 11/14), they got better. The success rate for sclerotherapy as the first treatment was 54% (n = 13/24), with 33% (n = 8/24) getting better with just sclerotherapy and 21% (n = 5/24) getting better after a second surgery (P = 0.011). 

Compared to patients who first had sclerotherapy, those who first had surgery had an adjusted chances ratio of 8.0 (95% CI: 1.1–59.1; P = 0.042) for resolution of prolapse. Markers of severity (like bleeding and the need for physical reduction) were not linked to the first treatment that was given (P = 0.064). Most children (63% of those surveyed) had their rectal prolapse fixed with surgery, such as sclerotherapy, rectopexy, or transanal resection. Surgery had a much higher success rate than sclerotherapy as the first treatment, even when the severity of the disease, mental diagnosis, need for manual reduction, and age were taken into account.

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