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Laparoscopic surgical technique to enhance the management of anorectal malformations: 330 cases’ experience in a single center

  • Long LiEmail author
  • Xianghai Ren
  • Anxiao Ming
  • Hang Xu
  • Rui Sun
  • Yan Zhou
  • Xuelai Liu
  • Hailin Sun
  • Qi Li
  • Xu Li
  • Zhen Zhang
  • Wei Cheng
  • Mei DiaoEmail author
  • Paul K. H. Tam
Original Article

Abstract

Purpose

Laparoscopic-assisted anorectoplasty (LAARP) is considered to benefit the patients with vesico-prostatic fistula. The aim of this study is to present the details of our LAARP technique for improving the short- and long-term outcomes in the patients with high and intermediate types of anorectal malformations (ARMs).

Methods

330 patients with high-type (174 cases) and intermediate-type (156 cases) anorectal malformation (aged 8 days to 15 years) underwent LAARP from 2001 to 2019. LAARP was performed for full mobilization and resection of the dilated rectum, intra-rectal closure of the fistula, visualization, and enlargement of the center of the longitudinal muscle tube (LMT) from pelvic and perineal aspects.

Results

LAARP was performed in all patients and no patient was converted to open procedure. The urethral diverticulum was found in three patients (1.02%, 3/294) according to postoperative protocol voiding cystourethrogram but was not associated with any symptoms such as urinary tract infection and dysuria. Rectal prolapse requiring surgical intervention developed in 25 (7.6%) of 330 patients. Anal stricture occurred in three patients and re-do anoplasty was performed 5 months after LAARP. Anal retraction occurred in two patients and re-pull-through was conducted at 5 and 6 days, respectively, after LAARP. 228 patients who were older than 3 years were followed up. The median follow-up period was 5.8 years (range 3–15 years). 217 patients (95.2%) had voluntary bowel movements; 202 patients (88.6%) were free from soiling or with grade 1 soiling; 30 patients (13.6%) and 25 patients (11.3%) suffered from grade 1 and grade 2 constipation, respectively, while no patient had grade 3 constipation.

Conclusion

Our experience demonstrates that the LAARP has advantages on rectal mobilization and resection, intra-rectal fistula closure and accurate tunnel formation in the LMT with minimal trauma. The improvement of the short-term and long-term outcomes after LAARP has been shown not only for high-type ARM but also for intermediate-type ARM.

Keywords

Laparoscopic-assisted anorectoplasty High-type anorectal malformation Intermediate-type anorectal malformation Sphincter muscle complex Long-term outcomes 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to disclose.

Research involving human participants

The study protocol was approved by our hospital medical ethics committees.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryCapital Institute of PediatricsBeijingPeople’s Republic of China
  2. 2.Graduate School of Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingPeople’s Republic of China
  3. 3.Department of Medical ImagingCapital Institute of PediatricsBeijingPeople’s Republic of China
  4. 4.Department of Pediatrics, Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonAustralia
  5. 5.New Century HealthcareHong KongPeople’s Republic of China
  6. 6.Dr. Li Dak Sum Research CentreThe University of Hong KongHong KongPeople’s Republic of China

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