Perineal mesh rectopexy with sterile talc in children with rectal prolapse

Our plain-English summary of Perineal mesh rectopexy with sterile talc in children with rectal prolapse, by M. Nazem, M. Hosseinpour, M. Farhadi (European Journal of Pediatric Surgery, 2010).

The study

• Authors: M. Nazem, M. Hosseinpour, M. Farhadi
• Journal: European Journal of Pediatric Surgery
• Published: 2010;20(5):321-4
• Type of article: Randomized trial
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: With such a wide variety of treatment options available for rectal prolapse and a variable success rate, the optimal treatment for this condition in children is still debated. In this study, we evaluated a technique of perineal mesh rectopexy with a sterile talc-soaked mesh and compared the success rates and complications of this method with those of abdominal rectopexy.

Methods And Materials: To examine the effect of therapeutic interventions, a randomized control trial (children were randomized into the case group or the control group) was carried out. In the control group, children were operated on by abdominal posterior mesh rectopexy. In the case group, a 30-cm sterile asbestos-free talc-soaked mesh was placed in the presacral space in a spiral fashion with the end exiting from the perineal incision. From 5 (th) day after surgery onward, the mesh was gradually extracted (10 cm per day) and completely removed by the 7 (th) postoperative day. On postoperative assessment, the duration of hospitalization, the postoperative complications and the success rates after surgery were compared. Patients were followed up for one year.

Results: In this study we evaluated 120 children. Mean age of the patients was 5.1±0.081 years in the case group and 4.91±0.59 years in the control group (p=NS). 34 patients in the case group were male vs. 41 patients in the control group. Results indicated that there was no statistically significant difference in postoperative complications between groups. The infection rate was 1.6% in the case group and 6.6% in the control group (p=NS).There was a higher resolution of constipation in the perineal rectopexy group (68.4% in the control group and 96.8% in the case group; p=0.002). The duration of hospitalization was 6.34±0.28 days in the case group and 6.68±0.31 days in the control group (p=NS).

Conclusion: Our findings suggest that perineal mesh rectopexy with sterile talc can be an alternative approach to abdominal surgery and offers an acceptable outcome with a low rate of complications.

© Georg Thieme Verlag KG Stuttgart · New York.

In plain English

This trial in Iran (June 2006 to April 2008) compared two operations for full-thickness rectal prolapse in 120 children who had not improved with non-surgical treatment. The authors called it a randomized controlled trial. Children with odd cart numbers went to the talc group and those with even numbers to the comparison group, 60 in each. The comparison group had abdominal mesh rectopexy. The talc group had an operation through the perineum, in which a 30-cm mesh soaked in sterile talc, described as asbestos-free, was placed behind the rectum and gradually pulled out by the seventh day. Children with a personal or family history of major lung disease or of lung, skin or ovarian cancer were excluded. Over one year, the table showed no statistically significant difference in complications, although one sentence in the results states the opposite. Among children with constipation, it resolved in 96.8% of the talc group and 68.4% of the comparison group (p = 0.002). Recurrence was 1.6% in each group. The authors concluded the talc technique offers an alternative to abdominal surgery, with acceptable outcomes and a low complication rate.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Described by the authors as a randomized controlled trial with two groups; allocation was by odd or even cart number. Follow-up lasted one year.
• Who was studied: Children consecutively admitted for elective surgery for full-thickness rectal prolapse that had not responded to conservative treatment, at a large pediatric surgery hospital in Iran, June 2006 to April 2008. Those with a medical diagnosis or family history of major pulmonary diseases, lung cancer, or skin or ovarian cancers were excluded.
• Exposure: Case group: perineal rectopexy with a 30-cm mesh soaked in sterile, asbestos-free talc (5 g of talc in 100 ml saline), placed in the presacral space and removed 10 cm per day from day 5 to day 7. Control group: abdominal posterior mesh rectopexy with prolene mesh.
• Main results:
  • 120 children were evaluated, 60 in the case (talc) group and 60 in the control (abdominal) group.
  • Postoperative infection: 4 of 60 (6.6%) in controls vs 1 (1.6%) in cases. Bleeding: 3 (5%) vs 1 (1.6%). Adhesion bands: 3 (5%) vs 0 (0%). All differences were reported as not significant (NS) in the table.
  • Resolution of constipation: 26 (68.4%) in controls vs 31 (96.8%) in cases, p = 0.002.
  • Improvement of continence: 11 (84.6%) in controls vs 10 (81.8%) in cases, not significant. Recurrence: 1 (1.6%) in each group, not significant.
  • Mean hospital stay was 6.34 days (SD 0.28) in the case group and 6.68 days (SD 0.31) in the control group, p = 0.7.
• The authors' conclusion: The authors concluded that perineal mesh rectopexy with sterile talc offers an alternative approach to abdominal surgery, with an acceptable outcome and a low rate of complications.
• Limitations the authors state:
  • The authors stated that they could not compare this technique with other perineal rectosigmoidectomy approaches.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc, Asbestos-Free Talc.

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• A review of perineal talc exposure and risk of ovarian cancer — B.L. Harlow, P.A. Hartge (1995)
• Perineal use of talc and risk of ovarian cancer — H. Langseth, S.E. Hankinson, et al. (2008)
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