Andrea Bischoff1, Alberto Peña, Marc A Levitt. 1. Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. andrea.bischoff@cchmc.org
Abstract
AIM: The aim of this study was to present an alternative way to use both the posterior sagittal approach combined with laparoscopy for the repair of select cases of anorectal malformation (ARM). METHODS: The laparoscopic approach was used for rectal dissection, ligation of the fistula, and division of vessels to pull the rectum down in cases of ARM with recto-bladderneck or high prostatic fistula. The posterior sagittal incision we believe made the perineal portion safer, allowing for rectal tapering when necessary, and for accurate placement of the rectum, anchored in the center of the sphincter. RESULTS: There were 15 children (recto-bladderneck fistula, n=13 and recto-prostatic fistula, n =2) in this series. There were no urethral injuries, posterior urethral diverticula, or rectal strictures. A laparotomy was needed in two children in order to mobilize a very high rectum. Follow-up ranged from 3 months to 10 years. Clinical results were consistent with our published series for male patients with these types of defects: 5 are fecally incontinent (3 are clean with a bowel management program), 1 is fecally continent, and 9 are too young to assess. Four children suffered rectal mucosal prolapse. CONCLUSION: The combination of laparoscopy and PSARP represents a useful technical alternative that allows for a safe reconstruction in cases of ARM with recto-bladderneck and in selected high prostatic fistulas.
AIM: The aim of this study was to present an alternative way to use both the posterior sagittal approach combined with laparoscopy for the repair of select cases of anorectal malformation (ARM). METHODS: The laparoscopic approach was used for rectal dissection, ligation of the fistula, and division of vessels to pull the rectum down in cases of ARM with recto-bladderneck or high prostatic fistula. The posterior sagittal incision we believe made the perineal portion safer, allowing for rectal tapering when necessary, and for accurate placement of the rectum, anchored in the center of the sphincter. RESULTS: There were 15 children (recto-bladderneck fistula, n=13 and recto-prostatic fistula, n =2) in this series. There were no urethral injuries, posterior urethral diverticula, or rectal strictures. A laparotomy was needed in two children in order to mobilize a very high rectum. Follow-up ranged from 3 months to 10 years. Clinical results were consistent with our published series for male patients with these types of defects: 5 are fecally incontinent (3 are clean with a bowel management program), 1 is fecally continent, and 9 are too young to assess. Four children suffered rectal mucosal prolapse. CONCLUSION: The combination of laparoscopy and PSARP represents a useful technical alternative that allows for a safe reconstruction in cases of ARM with recto-bladderneck and in selected high prostatic fistulas.