Mei Diao1, Long Li2, Kao-Ping Guan1, Zhen Zhang1, Wei Cheng3,4,5. 1. Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People's Republic of China. 2. Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People's Republic of China. lilong22@hotmail.com. 3. Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People's Republic of China. wei.cheng@monash.edu. 4. Department of Paediatrics and Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia. wei.cheng@monash.edu. 5. Department of Pediatric Surgery, Beijing United Family Hospital, Beijing, People's Republic of China. wei.cheng@monash.edu.
Abstract
BACKGROUND: The repair of anorectal malformation (ARM) with low recto-bulbar fistula (bowel-to-skin distance: 1-1.5 cm) is contraindicated for laparoscopy due to the difficulty in exposing the fistulae. Posterior or anterior sagittal anorectoplasty is thus conventionally carried out for low recto-bulbar fistula repair. However, these procedures carry the potential risk of wound infection/dehiscence and incontinence. We have developed a single-incision laparoscopic-assisted perineal anorectoplasty (SILPARP) technique. The current study aims to evaluate the safety and efficacy of this novel procedure. METHODS: Fifteen infants with ARMs and low recto-bulbar fistulae who underwent a SILPARP between November 2013 and March 2016 were reviewed. RESULTS: The mean distance between the rectal pouch and the perineal skin was 1.15 cm. The mean age at the time of surgery was 3.92 months. The average operative time was 1.60 h. All patients resumed feeding on postoperative day 1. The median follow-up duration was 7 months. No injury to blood vessels, the urethra or vas deferens was encountered in our series. No mortality, morbidity of wound infection, rectal retraction, anal stenosis, or rectal prolapse was encountered. The postoperative voiding cystourethrogram verified that there was no urethral diverticulum or recurrent fistula. Postoperative pelvic magnetic resonance imaging demonstrated that the distal rectum was located in the center of the pelvic muscle complex. CONCLUSIONS: SILPARP is a feasible alternative treatment for ARM infants with low recto-bulbar fistulae.
BACKGROUND: The repair of anorectal malformation (ARM) with low recto-bulbar fistula (bowel-to-skin distance: 1-1.5 cm) is contraindicated for laparoscopy due to the difficulty in exposing the fistulae. Posterior or anterior sagittal anorectoplasty is thus conventionally carried out for low recto-bulbar fistula repair. However, these procedures carry the potential risk of wound infection/dehiscence and incontinence. We have developed a single-incision laparoscopic-assisted perineal anorectoplasty (SILPARP) technique. The current study aims to evaluate the safety and efficacy of this novel procedure. METHODS: Fifteen infants with ARMs and low recto-bulbar fistulae who underwent a SILPARP between November 2013 and March 2016 were reviewed. RESULTS: The mean distance between the rectal pouch and the perineal skin was 1.15 cm. The mean age at the time of surgery was 3.92 months. The average operative time was 1.60 h. All patients resumed feeding on postoperative day 1. The median follow-up duration was 7 months. No injury to blood vessels, the urethra or vas deferens was encountered in our series. No mortality, morbidity of wound infection, rectal retraction, anal stenosis, or rectal prolapse was encountered. The postoperative voiding cystourethrogram verified that there was no urethral diverticulum or recurrent fistula. Postoperative pelvic magnetic resonance imaging demonstrated that the distal rectum was located in the center of the pelvic muscle complex. CONCLUSIONS: SILPARP is a feasible alternative treatment for ARM infants with low recto-bulbar fistulae.
Authors: Laurens D Eeftinck Schattenkerk; Gijsbert D Musters; David J Nijssen; Wouter J de Jonge; Ralph de Vries; L W Ernest van Heurn; Joep P M Derikx Journal: Innov Surg Sci Date: 2021-08-17