Rectal Prolapse Following Repair of Anorectal Malformation: Incidence, Risk Factors, and Management


Stephanie E. Iantorno, Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA. Electronic address:
Michael D. Rollins, Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
Kelly Austin, Department of Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Jeffrey R. Avansino, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Andrea Badillo, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, George Washington University, Washington, DC, USA.
Casey M. Calkins, Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
Rachel C. Crady, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Belinda H. Dickie, Department of Surgery, Boston Children's Hospital, Harvard University, Boston, MA, USA.
Megan M. Durham, Emory + Children's Pediatric Institute, Atlanta, GA, USA.
Jason S. Frischer, Department of Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Megan K. Fuller, Department of Surgery, Boys Town Research Hospital-Children's of Omaha, University of Nebraska Medical Center, Boys Town, NE, USA.
Julia E. Grabowski, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
Matthew W. Ralls, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Ron W. Reeder, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Rebecca M. Rentea, Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA.
Payam Saadai, Department of Surgery, UC Davis Children's Hospital, University of California Davis, Davis, CA, USA.
Richard J. Wood, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Kathleen D. van Leeuwen, Department of Surgery, Phoenix Children's Hospital, University of Arizona, Phoenix, AZ, USA.
Scott S. Short, Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.

Document Type

Journal Article

Publication Date



Journal of pediatric surgery








Anal strictures; Anorectal malformation; Rectal prolapse


BACKGROUND: The incidence and optimal management of rectal prolapse following repair of an anorectal malformation (ARM) has not been well-defined. METHODS: A retrospective cohort study was performed utilizing data from the Pediatric Colorectal and Pelvic Learning Consortium registry. All children with a history of ARM repair were included. Our primary outcome was rectal prolapse. Secondary outcomes included operative management of prolapse and anoplasty stricture following operative management of prolapse. Univariate analyses were performed to identify patient factors associated with our primary and secondary outcomes. A multivariable logistic regression was developed to assess the association between laparoscopic ARM repair and rectal prolapse. RESULTS: A total of 1140 patients met inclusion criteria; 163 (14.3%) developed rectal prolapse. On univariate analysis, prolapse was significantly associated with male sex, sacral abnormalities, ARM type, ARM complexity, and laparoscopic ARM repairs (p < 0.001). ARM types with the highest rates of prolapse included rectourethral-prostatic fistula (29.2%), rectovesical/bladder neck fistula (28.8%), and cloaca (25.0%). Of those who developed prolapse, 110 (67.5%) underwent operative management. Anoplasty strictures developed in 27 (24.5%) patients after prolapse repair. After controlling for ARM type and hospital, laparoscopic ARM repair was not significantly associated with prolapse (adjusted odds ratio (95% CI): 1.50 (0.84, 2.66), p = 0.17). CONCLUSION: Rectal prolapse develops in a significant subset of patients following ARM repair. Risk factors for prolapse include male sex, complex ARM type, and sacral abnormalities. Further research investigating the indications for operative management of prolapse and operative techniques for prolapse repair are needed to define optimal treatment. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: II.