First time use of trans-anal endorectal pull through (Soave procedure) for management of recurrent rectal mucosal prolapse in children not responding to the conventional sclerotherapy interventions: A case series

Abstract

Introduction

Recurrent rectal mucosal prolapse in pediatric patients poses a therapeutic challenge, particularly when conventional treatments like sclerotherapy fail. This case series evaluates the Transanal Endorectal Pull-Through (Soave) procedure as a surgical alternative for children unresponsive to sclerotherapy, emphasizing its ability to preserve sacral plexus integrity.

Case presentation

Three pediatric cases (6.5-, 10.5-, and 14-year-old boys) with chronic constipation and recurrent rectal mucosal prolapse, unresponsive to sclerotherapy, underwent the Soave procedure. Hospital stays lasted 7–8 days, with no intra- or postoperative complications. Follow-ups at 6–12 months showed no recurrence, resolution of constipation, and high guardian satisfaction.

Discussion

The Soave procedure demonstrated efficacy and safety in treating recurrent rectal mucosal prolapse, with no recurrences or complications over one year. Unlike rectopexy, which risks constipation and incontinence, the Soave procedure preserves rectal integrity, minimizing pelvic trauma. Despite limitations such as small sample size and short follow-up, findings align with literature supporting minimally invasive techniques. Further research, including multicenter studies with larger sample sizes, is needed to confirm long-term outcomes.

Conclusion

The Soave procedure is a promising surgical option for recurrent rectal mucosal prolapse in children unresponsive to sclerotherapy, offering reduced recurrence and complications. Larger, long-term studies are essential to validate its efficacy.