Most Common Complication of Rectal Prolapse Surgery in Children
Recurrence is the most common complication following corrective surgery for complete rectal prolapse in children, with rates varying significantly based on the surgical approach used.
Complication Profile by Surgical Approach
The complication landscape for rectal prolapse surgery is dominated by recurrence rates, which show substantial variation depending on technique:
Recurrence Rates
Perineal procedures (Altemeier, Delorme) demonstrate the highest recurrence rates, ranging from 5-21% in general populations, with some studies reporting rates as high as 40% 1, 2
Abdominal approaches (rectopexy with or without resection) show significantly lower recurrence rates of 0-8% 1, 3, 4
A 2023 network meta-analysis specifically found that posterior mesh rectopexy had significantly lower odds of recurrence compared to Altemeier procedure, Delorme procedure, resection rectopexy, sponge rectopexy, and sutured rectopexy 5
In pediatric populations specifically, laparoscopic mesh rectopexy has shown no recurrences in follow-up periods of 36 months 6, 7
Other Complications (Less Common)
While recurrence dominates the complication profile, other issues occur at lower frequencies:
Minor complications occur in up to 36% of cases but are generally self-limited 2
Bleeding occurs in 2-5% of cases 2
Infection (wound infections, urinary tract infections) occurs but at lower rates than recurrence 1, 2
Incontinence may persist or worsen in some cases, particularly with certain techniques, but this is less common than recurrence 1
Constipation can develop postoperatively, especially when lateral ligaments are divided during rectopexy, though this occurred in only isolated cases in pediatric series 1, 6, 7
Clinical Context for a 2-Year-Old
For a 2-year-old with complete rectal prolapse presenting with soiling and protruding mass:
The child would typically first undergo conservative management for up to 2 years before surgical intervention is considered 6, 7
If surgery becomes necessary, laparoscopic approaches (particularly mesh rectopexy) have shown excellent outcomes in pediatric populations with minimal recurrence 6, 7
The perineal approach, while having lower perioperative morbidity, carries the highest risk of the most common complication—recurrence 1
Answer: B. Recurrence
Recurrence rates of 4-40% across all techniques make this the most common complication, far exceeding the rates of incontinence, infection, or bleeding 1, 5, 2.