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A novel combined enteroscopy and laparoscopy approach to prevent urethral complications in management of rectourethral fistula

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Abstract

Background

For the last 20 years, laparoscopy management of anorectal malformations (ARM) has been challenged due to the development of postoperative urethral diverticulum or injury caused by the imprecise transection of rectourethral fistulae, particularly rectobulbar fistulae situated deep in the pelvis. We have developed a combined approach of enteroscopy and laparoscopy for intraluminal incision of a rectourethral fistula.

Methods

We retrospectively reviewed 47 ARM patients who underwent surgical corrections using the combined approach between January 2019 and June 2020. Early postoperative and subsequent follow-up results were evaluated.

Results

The median follow-up period was 12 months. The average age at surgery was 3.18 ± 0.64 months. The mean operative time of a single-incision laparoscopic-assisted anorectoplasty (SILAARP) was 1.19 ± 0.29 h. The time for intraluminal incision of the fistula was shortened from 14 to 2 min. No patients underwent a conversion. The average postoperative hospital stay, time to full feeds and placement of an anal tube were 10 days, 1 day, and 5 days, respectively. No urethral diverticulum, urinary injury, wound infection, rectal retraction, anal stenosis or rectal prolapse was encountered in the cohort.

Conclusions

The combined enteroscopy and laparoscopy approach offers precise management of rectourethral fistulae. It could effectively obviate urethral complications, eliminating the obstacles of laparoscopy application in the management of ARMs.

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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, Chi-Huan Kong, Qi Li, An-Xiao Ming & Zhen Zhang

  2. Department of Paediatric Surgery, Monash Children’s, Monash Medical Center, Southern Health, Clayton, Australia

    Wei Cheng

  3. Department of Paediatrics and Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia

    Wei Cheng

  4. New Century Healthcare, Hong Kong, People’s Republic of China

    Wei Cheng

Authors
  1. Mei Diao
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  2. Long Li
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  3. Chi-Huan Kong
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  4. Qi Li
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  5. An-Xiao Ming
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  6. Zhen Zhang
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  7. Wei Cheng
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Correspondence to Long Li or Wei Cheng.

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Mei Diao, Long Li, Chi-Huan Kong, Qi Li, An-Xiao Ming, Zhen Zhang, and Wei Cheng declare no conflicts of interest or have any financial ties to disclose.

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Diao, M., Li, L., Kong, CH. et al. A novel combined enteroscopy and laparoscopy approach to prevent urethral complications in management of rectourethral fistula. Surg Endosc 35, 1921–1926 (2021). https://doi.org/10.1007/s00464-020-08268-y

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  • DOI: https://doi.org/10.1007/s00464-020-08268-y

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