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Long-term outcomes of male imperforate anus with recto-urethral fistula: laparoscopy-assisted anorectoplasty versus posterior sagittal anorectoplasty

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Abstract

Purpose

A five-parameter fecal continence evaluation questionnaire (FCEQ) and incidence of complications were used for long-term assessment of laparoscopy-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) for treating male imperforate anus (MIA) with rectobulbar (RB) or rectoprostatic (RP) fistulas.

Methods

Subjects were 64 consecutive Japanese MIA patients with RB or RP fistulas treated at a single institution between 1995 and 2021. FCEQ data collected retrospectively were used to calculate a fecal continence evaluation (FCE) score (best = 10) and coefficient of variation for FCE (FCECV). The statistical significance threshold was defined at p < 0.05.

Results

Fistulas were RB (n = 40; LAARP = 25/40, PSARP = 15/40) or RP (n = 24; LAARP = 17/24, PSARP = 7/24). Mean ages at surgery and status of the sacrum were similar (p = 0.06, 0.05 and 0.51). FCE scores in RP-LAARP were consistently higher with less FCECV but differences were only statistically significant from 7 years postoperatively (p < 0.05). While FCE scores for RB-LAARP and RB-PSARP were similar (p = 0.99), FCECV were lower for RB-LAARP compared with RB-PSARP. LAARP was associated with less-wound infections, but greater incidence of anal mucosal prolapse unrelated to preoperative status of the sacrum.

Conclusion

Long-term postoperative FCEQ assessment favored LAARP for treating MIA with either RB or RP fistulas.

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References

  1. Georgeson KE, Inge TH, Albanese CT (2000) Laparoscopically assisted anorectal pull-through for high imperforate anus—a new technique. J Pediatr Surg 35:927–930. https://doi.org/10.1053/jpsu.2000.6925 (discussion 30–1)

    Article  CAS  PubMed  Google Scholar 

  2. Al-Hozaim O, Al-Maary J, AlQahtani A, Zamakhshary M (2010) Laparoscopic-assisted anorectal pull-through for anorectal malformations: a systematic review and the need for standardization of outcome reporting. J Pediatr Surg 45:1500–1504. https://doi.org/10.1016/j.jpedsurg.2009.12.001

    Article  PubMed  Google Scholar 

  3. Han Y, Xia Z, Guo S, Yu X, Li Z (2017) Laparoscopically assisted anorectal pull-through versus posterior sagittal anorectoplasty for high and intermediate anorectal malformations: a systematic review and meta-analysis. PLoS ONE 12:e0170421. https://doi.org/10.1371/journal.pone.0170421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Yazaki Y, Koga H, Ochi T, Okawada M, Doi T, Lane GJ et al (2016) Surgical management of recto-prostatic and recto-bulbar anorectal malformations. Pediatr Surg Int 32:939–944. https://doi.org/10.1007/s00383-016-3948-4

    Article  PubMed  Google Scholar 

  5. Ichijo C, Kaneyama K, Hayashi Y, Koga H, Okazaki T, Lane GJ et al (2008) Midterm postoperative clinicoradiologic analysis of surgery for high/intermediate-type imperforate anus: prospective comparative study between laparoscopy-assisted and posterior sagittal anorectoplasty. J Pediatr Surg 43:158–162. https://doi.org/10.1016/j.jpedsurg.2007.09.037 (discussion 62–3)

    Article  PubMed  Google Scholar 

  6. Koga H, Miyano G, Takahashi T, Shimotakahara A, Kato Y, Lane GJ et al (2010) Comparison of anorectal angle and continence after Georgeson and Pena procedures for high/intermediate imperforate anus. J Pediatr Surg 45:2394–2397. https://doi.org/10.1016/j.jpedsurg.2010.08.041

    Article  PubMed  Google Scholar 

  7. Koga H, Ochi T, Okawada M, Doi T, Lane GJ, Yamataka A (2014) Comparison of outcomes between laparoscopy-assisted and posterior sagittal anorectoplasties for male imperforate anus with recto-bulbar fistula. J Pediatr Surg 49:1815–1817. https://doi.org/10.1016/j.jpedsurg.2014.09.028

    Article  PubMed  Google Scholar 

  8. deVries PA, Pena A (1982) Posterior sagittal anorectoplasty. J Pediatr Surg 17:638–643. https://doi.org/10.1016/s0022-3468(82)80126-7

    Article  CAS  PubMed  Google Scholar 

  9. Koga H, Okazaki T, Yamataka A, Kobayashi H, Yanai T, Lane GJ et al (2005) Posterior urethral diverticulum after laparoscopic-assisted repair of high-type anorectal malformation in a male patient: surgical treatment and prevention. Pediatr Surg Int 21:58–60. https://doi.org/10.1007/s00383-004-1265-9

    Article  PubMed  Google Scholar 

  10. Koga H, Okawada M, Miyano G, Doi T, Lane GJ, Yamataka A (2017) Is measuring the residual rectourethral fistula during laparoscopically assisted anorectal pull-through for male high/intermediate type imperforate anus beneficial? Mid-term follow-up. J Pediatr Surg 52:1994–1996. https://doi.org/10.1016/j.jpedsurg.2017.08.042

    Article  PubMed  Google Scholar 

  11. Ong NT, Beasley SW (1991) Long-term continence in patients with high and intermediate anorectal anomalies treated by sacroperineal (Stephens) rectoplasty. J Pediatr Surg 26:44–48. https://doi.org/10.1016/0022-3468(91)90424-r

    Article  CAS  PubMed  Google Scholar 

  12. Pena A, Hong A (2000) Advances in the management of anorectal malformations. Am J Surg 180:370–376. https://doi.org/10.1016/s0002-9610(00)00491-8

    Article  CAS  PubMed  Google Scholar 

  13. Pena A, Amroch D, Baeza C, Csury L, Rodriguez G (1999) The effects of the posterior sagittal approach on rectal function (experimental study). J Pediatr Surg 28:773–778. https://doi.org/10.1016/0022-3468(93)90323-d

    Article  Google Scholar 

  14. Koga H, Kato Y, Shimotakahara A, Miyano G, Lane GJ, Okazaki T et al (2010) Intraoperative measurement of rectourethral fistula: prevention of incomplete excision in male patients with high-/intermediate-type imperforate anus. J Pediatr Surg 45:397–400. https://doi.org/10.1016/j.jpedsurg.2009.10.085

    Article  PubMed  Google Scholar 

  15. Koga H, Chen SY, Murakami H, Miyano G, Ochi T, Lane GJ et al (2019) Fact or myth? The long shared common wall between the fistula and the urethra in male anorectal malformation with urethral bulbar fistula. Pediatr Surg Int 35:247–251. https://doi.org/10.1007/s00383-018-4404-4

    Article  PubMed  Google Scholar 

  16. Ishimaru T, Hosokawa T, Kawashima H, Hayashi K, Takayama S, Omata K et al (2020) Rectal prolapse after laparoscopically assisted anorectoplasty for anorectal malformations. J Laparoendosc Adv Surg Tech A 30:1277–1281. https://doi.org/10.1089/lap.2020.0609

    Article  PubMed  Google Scholar 

  17. Pathak M, Saxena AK (2000) Postoperative “complications” following laparoscopic-assisted anorectoplasty: a systematic review. Pediatr Surg Int 36:1299–1307. https://doi.org/10.1007/s00383-020-04748-3

    Article  Google Scholar 

  18. Jung SM, Lee SK, Seo JM (2013) 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 48:591–596. https://doi.org/10.1016/j.jpedsurg.2012.08.001

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Hiroyuki Koga, Yuichiro Miyake, Yuta Yazaki, Takanori Ochi, Shogo Seo, Geoffrey J. Lane & Atsuyuki Yamataka

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  1. Hiroyuki Koga
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  2. Yuichiro Miyake
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  3. Yuta Yazaki
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  4. Takanori Ochi
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  5. Shogo Seo
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  6. Geoffrey J. Lane
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  7. Atsuyuki Yamataka
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Correspondence to Hiroyuki Koga.

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Koga, H., Miyake, Y., Yazaki, Y. et al. Long-term outcomes of male imperforate anus with recto-urethral fistula: laparoscopy-assisted anorectoplasty versus posterior sagittal anorectoplasty. Pediatr Surg Int 38, 761–768 (2022). https://doi.org/10.1007/s00383-022-05106-1

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