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Laparoscopic Management of Perineal Descent Syndrome in Pediatric Age Group

ABSTRACT Background: Perineal descent syndrome is a disease that affects the pelvic floor because of denervation of its muscles, resulting in obstructed defecation. Hints on the anatomy that may be associated with the work got, and the physiology of the anorectum was explained, discussing factors leading to continence and mechanism of defecation was presented. Objective: to diagnose the perineal descent syndrome in both cases of chronic constipation and anal incontinence and the use of laparoscopy in the management of PDS in children where the pathophysiologic changes for each case is identified and dealt with laparoscopically. Patients and Methods: This study was a prospective case study that had been conducted in pediatric surgery department, Al-Azhar university hospitals during the period from June 2019 to June 2020 after approval from the ethical review committee of Al-Azhar faculty of medicine. The study included 30 patients presented to the outpatient clinics with constipation or Fecal incontinence whom fulfilled the required Criteria. Results: In our study (n=30), 2 recurrent cases (13.3%) were found after laparoscopic suture rectopexy. Recurrence rates with mesh rectopexy or resection rectopexy was zero % and chronic conistipation and fecal incontinence are considered as a hidden cause for perineal descent syndrome. Conclusion: The anterior rectal wall has a great dynamic role in defecation thanks to its viscoelastic properties. Any rectopexy technique should never interfere or impede this vital mechanism of action. Finally chronic conistipation and fecal incontinence are considered as a hidden cause for perineal descent syndrome.