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Congenital anomaly rectified at birth: one-stage single-incision laparoscopic-assisted anorectoplasty for newborns with anorectal malformations and recto-urethral fistula

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Abstract

Objective

Currently, staged procedures involving stoma formation and closure are the widely accepted treatment for newborns suffering from anorectal malformations (ARM) with recto-urethral fistula. This study aims to evaluate the safety and efficacy of one-stage single-incision laparoscopic-assisted anorectoplasty (SILAARP) as an alternative to the conventional approach.

Methods

Newborns with ARMs and recto-urethral fistula who underwent one-stage SILAARP between June 2013 and December 2014 were reviewed. The procedure involved decompression of the meconium via a small temporary incision of the proximal sigmoid colon followed by a laparoscopic-assisted pull-through.

Results

Sixteen ARM newborns [recto-prostatic fistula (6), recto-bulbar fistula (10)] successfully underwent a one-stage SILAARP. The mean age of the neonates at operation was 42.1 h. The average operative time was 2.4 h. The actual pull-through took 1.7 h, which did not differ significantly from 1.9 h in the pull-through procedure of our three-stage SILAARP control group. The median follow-up period was 16 months (8–26 months). No complications were encountered. Postoperative pelvic magnetic resonance imaging verified the centrally placed rectum within the muscle complex. Most patients started having bowel movements on postoperative day 1. Two constipated patients periodically required an enema for 1–3 months.

Conclusions

One-stage SILAARP is safe and effective. It provides complete rectification of ARM with recto-urethral fistula immediately after birth with good cosmesis.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People’s Republic of China

    Mei Diao, Long Li, Mao Ye, Kao-Ping Guan, Yan-Dong Wei & Wei Cheng

  2. 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

  3. Department of Surgery, Beijing United Family Hospital, Beijing, People’s Republic of China

    Wei Cheng

Authors
  1. Mei Diao
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  2. Long Li
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  3. Mao Ye
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  4. Kao-Ping Guan
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  5. Yan-Dong Wei
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  6. Wei Cheng
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Corresponding authors

Correspondence to Long Li or Wei Cheng.

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Disclosures

Dr. Mei DIAO, Prof. Long Li, Dr. Mao Ye, Dr Kao-Ping Guan, Dr Yan-Dong Wei and Prof. Wei Cheng declare no conflicts of interest or financial ties to disclose.

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Diao, M., Li, L., Ye, M. et al. Congenital anomaly rectified at birth: one-stage single-incision laparoscopic-assisted anorectoplasty for newborns with anorectal malformations and recto-urethral fistula. Surg Endosc 30, 5156–5164 (2016). https://doi.org/10.1007/s00464-016-4841-x

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  • DOI: https://doi.org/10.1007/s00464-016-4841-x

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