Laparoscopic assisted anorectoplasty in children: a prospective study

Authors

  • Sanjay Raina Department of Paediatric Surgery, BHU, Varanasi, India
  • Beena Jad Department of Microbiology, GMC, Jammu, India
  • Vijayendra Kumar Department of Paediatric Surgery, BHU, Varanasi, India
  • S. P. Sharma Department of Paediatric Surgery, BHU, Varanasi, India
  • Nilay Kumar Department of Paediatric Surgery, BHU, Varanasi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20160219

Keywords:

Laparoscopic assisted anorectoplasty, Anorectal malformations, Posterior sagittal anorectoplasty, Abdomino-perineal pull through

Abstract

Background: Anorectal malformations are a spectrum of congenital defects that continue to represent a significant challenge for the paediatric surgeon. Development of minimally invasive surgery has probably been the biggest revolution in surgical practice in last two decades, which has gone through a period of rapid development during last 10 years; one of such changing procedure is LAARP for ARM. The aim of this study is to evaluate the clinical and functional outcomes in children with anorectal malformation treated by LAARP.   

Methods: From Sep.2012 to June 2014, 16 patients with intermediate and high imperforate anus underwent LAARP. Inclusion criteria were children with ARM, age >3 months, stage I sigmoid colostomy, with no associated morbid anomaly, Operative procedure followed was that given by Georgeson KE (2000).

Results: 16 cases were included in this study out of which males were 87.5%. The most common ARM type was rectobulbar fistula (50%). The mean operative time was 2.75 hrs approx. and mean blood loss 24 ml approx. Conversion rate to APPT was 25%. The mean length of hospital stay was shorter (8 day’s approx). Few postoperative complications were mucosal prolapse 6.25%, stenosis 12.5%, and peritoneal contamination with faecal matter 12.5%, temporary neurogenic bladder 12.5%.

Conclusions: Laparoscopically assisted anorectal pull-through has advantages, including shorter hospital stay, minimal blood loss and better functional outcome. Satisfactory rectal continence can be achieved in children with imperforate anus after LAARP. Shorter dissection of rectum in the intra-abdominal space may be helpful in preventing rectal mucosal prolapse.  

References

Pena A, Hong A. Advances in the management of anorectal malformations. Am J Surg. 2000;180:370-6.

Santulli TV. The treatment of imperforate anus and associated fistulas. Surg Gynecol Obstet. 1952;95:601-14.

Al-Hozaim O, Al-Maary J, Al-Qahtani A, Zamakhshary M. Laparoscopic-assisted anorectal pull-through for anorectal malformations: a systematic review and the need for standardization of outcome reporting. J Pediatr Surg. 2010;45:1500-4.

Willital GH. Endosurgical intrapuborectal reconstruction of high anorectal anomalies. Pediatr Endosurg Innov Tech. 1998;2:5-11.

Elbarbary MM, Fares AE, Saket HE. Laproscopically assisted anorectoplasty: A new definitive repair of high imperforate anus. Annals of Pediatric Surgery. 2008;4:1-7.

Bhandary KS, Kumaran V, Rajamani G. Laproscopic assisted anorectal pull through: reformed techniques. J Indian Assoc Pediatr Surg. 2009;14:210-4.

Kudou S, Iwanaka T, Kawashima H. Midterm follow-up study of high-type imperforate anus after laproscopically assisted anorectoplasty. J Pediatr Surg. 2005;40:1923-6.

Georgeson KE, Inge TH, Albanese CT. Laproscopically assisted anorectal pull-through for high imperforate anus – a new technique. J Pediatr Surg. 2000;35:927-31.

Iwai N, Fumino S. Surgical treatment of anorectal malformations. Surg Today. 2013;43:955-62.

Shandip S, Ravi PK, Ashish W. Delayed presentation of anorectal malformations. J Indian Assoc Pediatr Surg. 2008;13:64-8.

Tong QS, Tang ST, Pu JR. Laproscopically assisted anorectal pull-through for high imperforate anus in infants: intermediate results. J Pediatr Surg. 2011;46:1578-86.

Jung SM, Lee SK, Seo JM. Experience with laparoscopic-assisted anorectal pull-through in 25 males with anorectal malformation and rectourethral or rectovesical fistulae: postoperative complications and functional results. J Pediatr Surg. 2013;48:591-6.

De Vos C, Arnold M, Sidler D, Moore SW. A comparison of laparoscopic-assisted (LAARP) and posterior sagittal (PSARP) anorectoplasty in the outcome of intermediate and high anorectal malformations. S Afr J Surg. 2011;14,49(1):39-43.

Stephens FD, Smith ED. Anorectal Malformations in Children. Chicago: Year Book Medical Publishers. 1971.

Rintala R, Lindahl H, Louhimo I. Anorectal malformations – results of treatment and long term follow-up of 208 patients. Pediatr Surg Int. 199I;6:36-41.

Iwanaka T, Arai M, Kawashima H. Findings of pelvic musculature and efficacy of laparoscopic muscle stimulator in laparoscopy assisted anorectal pull-through for high imperforate. Surg Endosc. 2003;17:278-81.

Ming AX, Li L, Diao M, Wang HB, Liu Y, Ye M. Long term outcomes of laparoscopic-assisted anorectoplasty: a comparison study with posterior sagittal anorectoplasty. J Pediatr Surg. 2014;49(4):560-3.

Downloads

Published

2016-12-13

Issue

Section

Original Research Articles