Skip to main content
SpringerLink
Log in

Postoperative “complications" following laparoscopic-assisted anorectoplasty: A systematic review

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Aim

This study reviewed the literature on the postoperative complications following laparoscopic-assisted anorectoplasty (LAARP).

Methods

A Medline and Embase search was performed for the terms “anorectal malformation” (ARM) “laparoscopic” and “complication”. Articles without English full text, review articles, systematic reviews, case reports, case series < 5 cases and duplicate articles were excluded. Two reviewers independently performed the eligibility assessment and data extraction. Data were collected for type of malformation, surgical technique, postoperative complications and functional outcomes

Results

The search retrieved 108 articles, of which 38 met the inclusion criteria and offered 1058 patients for analysis. Rectoprostatic and rectobladder neck fistula were the most common types of ARM in males, whereas it was the common cloaca in females. Analysis of complications demonstrated rectal prolapse (n = 149; 14.08%) being the most prominent, followed by urethral diverticulum (n = 32; 3.02%), anal stenosis (n = 37; 3.49%), recurrent fistula (n = 7; 0.66%) and rectal stricture (n = 4; 0.37%). Krickenbeck classification was used for functional assessment in 638 patients, with fecal soiling grade 2 or > 2 in 79. Data on functional outcome specific to the type of malformation was available for 246 patients: fecal soiling grade 2 or > 2 in 15/94 (15.95%) with rectoprostatic fistula, 26/73 (35.61%) with rectobladder neck fistula, 6/47 (12.76%) with common cloaca, and 1/22 (4.54%) with no fistula.

Conclusion

Rectal prolapse, posterior urethral diverticulum and anal stenosis are the most common complications after LAARP. Inconsistent and non-uniform functional assessment and non-availability of information about the sacrum and spine make it difficult to analyze the functional outcome following LAARP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. DeVries PA, Peña 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 

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

  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(1):e0170421. https://doi.org/10.1371/journal.pone.0170421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:W65–W94

    Article  Google Scholar 

  5. Iwanaka T, Arai M, Kawashima H, Kudou S, Fujishiro J, Matsui A, Imaizumi S (2003) Findings of pelvic musculature and efficacy of laparoscopic muscle stimulator in laparoscopy-assisted anorectal pull-through for high imperforate anus. Surg Endosc 17:278–281. https://doi.org/10.1007/s00464-002-9054-9

    Article  CAS  PubMed  Google Scholar 

  6. Tei E, Yamataka A, Segawa O, Kobayashi H, Lane GJ, Tobayama S, Kameoka S, Miyano T (2003) Laparoscopically assisted anorectovaginoplasty for selected types of female anorectal malformations. J Pediatr Surg 38:1770–1774. https://doi.org/10.1016/j.jpedsurg.2003.08.018

    Article  PubMed  Google Scholar 

  7. Kudou S, Iwanaka T, Kawashima H, Uchida H, Nishi A, Yotsumoto K, Kaneko M (2005) Midterm follow-up study of high-type imperforate anus after laparoscopically assisted anorectoplasty. J Pediatr Surg 40:1923–1926. https://doi.org/10.1016/j.jpedsurg.2005.08.008

    Article  PubMed  Google Scholar 

  8. Ichijo C, Kaneyama K, Hayashi Y, Koga H, Okazaki T, Lane GJ, Kurosaki Y, Yamataka A. 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. 2008;43:158–62; discussion 162–3. doi: https://doi.org/10.1016/j.jpedsurg.2007.09.037.

  9. El-Debeiky MS, Safan HA, Shafei IA, Kader HA, Hay SA (2009) Long-term functional evaluation of fecal continence after laparoscopic-assisted pull-through for high anorectal malformations. J Laparoendosc Adv Surg Tech A 19(Suppl 1):S51–S54. https://doi.org/10.1089/lap.2008.0135.supp

    Article  PubMed  Google Scholar 

  10. Podevin G, Petit T, Mure PY, Gelas T, Demarche M, Allal H, Becmeur F, Varlet F, Philippe P, Weil D, Heloury Y (2009) Minimally invasive surgery for anorectal malformation in boys: a multicenter study. J Laparoendosc Adv Surg Tech A 19(Suppl 1):S233–S235. https://doi.org/10.1089/lap.2008.0137.supp

    Article  PubMed  Google Scholar 

  11. Bhandary KS, Kumaran V, Rajamani G, Kannan S, Mohan NV, Rangarajan R, Muthulingam V (2009) Laparoscopic assisted anorectal pull through: reformed techniques. J Indian Assoc Pediatr Surg 14:210–214. https://doi.org/10.4103/0971-9261.59604

    Article  PubMed  PubMed Central  Google Scholar 

  12. Koga H, Miyano G, Takahashi T, Shimotakahara A, Kato Y, Lane GJ, Okazaki T, Yamataka A (2010) Comparison of anorectal angle and continence after Georgeson and Peña 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 

  13. Bailez MM, Cuenca ES, Di Benedetto V, Solana J. Laparoscopic treatment of rectovaginal fistulas. Feasibility, technical details, and functional results of a rare anorectal malformation. J Pediatr Surg. 2010;45:1837–42. doi: https://doi.org/10.1016/j.jpedsurg.2010.02.064.

  14. Kimura O, Iwai N, Sasaki Y, Tsuda T, Deguchi E, Ono S, Furukawa T (2010) Laparoscopic versus open abdominoperineal rectoplasty for infants with high-type anorectal malformation. J Pediatr Surg 45:2390–2393. https://doi.org/10.1016/j.jpedsurg.2010.08.042

    Article  PubMed  Google Scholar 

  15. Bailez MM, Cuenca ES, Mauri V, Solana J, Di Benedetto V (2011) Outcome of males with high anorectal malformations treated with laparoscopic-assisted anorectal pull-through: preliminary results of a comparative study with the open approach in a single institution. J Pediatr Surg 46:473–477. https://doi.org/10.1016/j.jpedsurg.2010.08.007

    Article  PubMed  Google Scholar 

  16. Tong QS, Tang ST, Pu JR, Mao YZ, Wang Y, Li SW, Cao QQ, Ruan QL (2011) Laparoscopically assisted anorectal pull-through for high imperforate anus in infants: intermediate results. J Pediatr Surg 46:1578–1586. https://doi.org/10.1016/j.jpedsurg.2011.04.059

    Article  PubMed  Google Scholar 

  17. England RJ, Warren SL, Bezuidenhout L, Numanoglu A, Millar AJ (2012) Laparoscopic repair of anorectal malformations at the Red Cross War Memorial Children's Hospital: taking stock. J Pediatr Surg 47:565–570. https://doi.org/10.1016/j.jpedsurg.2011.08.006

    Article  PubMed  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 

  19. Bischoff A, Peña A, Levitt MA (2013) Laparoscopic-assisted PSARP—the advantages of combining both techniques for the treatment of anorectal malformations with recto-bladder neck or high prostatic fistulas. J Pediatr Surg 48:367–371. https://doi.org/10.1016/j.jpedsurg.2012.11.019

    Article  PubMed  Google Scholar 

  20. Liem NT, Quynh TA (2012) Laparoscopic rectal pull-through for persistent cloaca: an easier approach for a complex anomaly. J Pediatr Surg 47:815–818. https://doi.org/10.1016/j.jpedsurg.2012.02.004

    Article  PubMed  Google Scholar 

  21. Yamataka A, Goto S, Kato Y, Koga H, Lane GJ, Okazaki T (2012) Fecal and urinary continence after scope-assisted anorectovaginoplasty for female anorectal malformation. Pediatr Surg Int 28:907–912. https://doi.org/10.1007/s00383-012-3141-3(PMID: 22940880)

    Article  PubMed  Google Scholar 

  22. Liem NT, Quynh TA (2013) Combined laparoscopic and modified posterior sagittal approach saving the external sphincter for rectourethral fistula: an easier and more physiologic approach. J Pediatr Surg 48:1450–1453. https://doi.org/10.1016/j.jpedsurg.2013.03.007

    Article  CAS  PubMed  Google Scholar 

  23. Japanese multicenter study group on male high imperforate anus. Multicenter retrospective comparative study of laparoscopically assisted and conventional anorectoplasty for male infants with rectoprostatic urethral fistula. J Pediatr Surg. 2013;48:2383–8. doi: https://doi.org/10.1016/j.jpedsurg.2013.08.010.

  24. van der Zee DC, Dik P, Beek FJ (2013) Laparoscopy-assisted anorectal pull-through in anorectal malformations: a reappraisal. World J Surg 37:1934–1939. https://doi.org/10.1007/s00268-013-2017-6

    Article  PubMed  Google Scholar 

  25. Ming AX, Li L, Diao M, Wang HB, Liu Y, Ye M, Cheng W (2014) Long term outcomes of laparoscopic-assisted anorectoplasty: a comparison study with posterior sagittal anorectoplasty. J Pediatr Surg 49:560–563. https://doi.org/10.1016/j.jpedsurg.2013.11.060

    Article  PubMed  Google Scholar 

  26. Yang L, Tang ST, Li S, Aubdoollah TH, Cao GQ, Lei HY, Wang XX (2014) Two-stage laparoscopic approaches for high anorectal malformation: transumbilical colostomy and anorectoplasty. J Pediatr Surg 49:1631–1634. https://doi.org/10.1016/j.jpedsurg.2014.05.014

    Article  PubMed  Google Scholar 

  27. Wang C, Li L, Cheng W, Liu S, Diao M, Li X, Qiao G, Zhang Z, Chen Z (2015) A new approach for persistent cloaca: laparoscopically assisted anorectoplasty and modified repair of urogenital sinus. J Pediatr Surg 50:1236–1240. https://doi.org/10.1016/j.jpedsurg.2015.04.016

    Article  PubMed  Google Scholar 

  28. Minaev SV, Kirgizov IV, Gladkyy A, Shishkin I, Gerasimenko I (2017) Outcome of laparoscopic treatment of anorectal malformations in children. World J Surg 41:625–629. https://doi.org/10.1007/s00268-016-3699-3

    Article  PubMed  Google Scholar 

  29. Yazaki Y, Koga H, Ochi T, Okawada M, Doi T, Lane GJ, Yamataka A. Surgical management of recto-prostatic and recto-bulbar anorectal malformations. Pediatr Surg Int. 2016;32:939–44. https://doi.org/10.1007/s00383-016-3948-4

  30. Diao M, Li L, Ye M, Guan KP, Wei YD, Cheng W (2016) 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. https://doi.org/10.1007/s00464-016-4841-x

    Article  PubMed  Google Scholar 

  31. Samuk I, Bischoff A, Hall J, Levitt M, Peña A (2016) Anorectal malformation with rectobladder neck fistula: a distinct and challenging malformation. J Pediatr Surg 51:1592–1596. https://doi.org/10.1016/j.jpedsurg.2016.06.001

    Article  PubMed  Google Scholar 

  32. Wang C, Li L, Diao M, Liu S, Zhang J, Chen Z, Li X, Cheng W (2016) Single-incision laparoscopic-assisted anorectoplasty for the management of persistent cloaca. J Laparoendosc Adv Surg Tech A 26:328–333. https://doi.org/10.1089/lap.2015.0296

    Article  PubMed  Google Scholar 

  33. Diao M, Li L, Guan KP, Zhang Z, Cheng W (2017) A novel laparoscopic technique for anorectal malformation with low recto-bulbar fistulae. Surg Endosc 31:4326–4330. https://doi.org/10.1007/s00464-017-5483-3(Epub 2017 Mar 13 PMID: 28289973)

    Article  PubMed  Google Scholar 

  34. Tainaka T, Uchida H, Tanaka Y, Hinoki A, Shirota C, Sumida W, Yokota K, Makita S, Oshima K, Chiba K, Ishimaru T, Kawashima H. Long-term outcomes and complications after laparoscopic-assisted anorectoplasty vs. posterior sagittal anorectoplasty for high- and intermediate-type anorectal malformation. Pediatr Surg Int. 2018;34:1111–1115. doi: https://doi.org/10.1007/s00383-018-4323-4.

  35. Ren X, Xiao H, Li L, Diao M, Chen L, Zhou R, Li H, Li X, Cheng W (2018) Single-incision laparoscopic-assisted anorectoplasty versus three-port laparoscopy in treatment of persistent cloaca: a midterm follow-up. J Laparoendosc Adv Surg Tech A 28:1540–1547. https://doi.org/10.1089/lap.2018.0225

    Article  PubMed  Google Scholar 

  36. Xiao H, Huang R, Cui X, Chen L, Diao M, Li L (2018) Single-incision laparoscopic versus conventional laparoscopic surgery for rectobladderneck and rectoprostatic anorectal malformations. J Laparoendosc Adv Surg Tech A 28:1553–1557. https://doi.org/10.1089/lap.2018.0260

    Article  PubMed  Google Scholar 

  37. Xiao H, Chen L, Ren XH, Huang R, Diao M, Li L (2018) One-stage laparoscopic-assisted anorectoplasty for neonates with anorectal malformation and recto-prostatic or recto-bulbar fistula according to the krickenbeck classification. J Laparoendosc Adv Surg Tech A 28:1029–1034. https://doi.org/10.1089/lap.2017.0690

    Article  PubMed  Google Scholar 

  38. Xiao H, Huang R, Chen L, Diao M, Cheng W, Li L, Cui XD (2018) The midterm outcomes of 1-stage versus 3-stage laparoscopic-assisted anorectoplasty in anorectal malformations with rectoprostatic fistula and rectobulbar fistula: a retrospective cohort study. Medicine (Baltimore) 97:e11843. https://doi.org/10.1097/MD.0000000000011843

    Article  Google Scholar 

  39. Tran QA, Nguyen LT, Pham HD, Nguyen TTN, Nguyen XV (2019) Follow-up outcomes of laparoscopic-assisted anorectal pull through for anorectal malformations of high type. J Laparoendosc Adv Surg Tech A 29:1497–1500. https://doi.org/10.1089/lap.2018.0163

    Article  PubMed  Google Scholar 

  40. Ren X, Xu H, Jiang Q, Diao M, Li X, Li L (2019) Single-incision laparoscopic-assisted anorectoplasty for treating children with intermediate-type anorectal malformations and rectobulbar fistula: a comparative study. Pediatr Surg Int 35:1255–1263. https://doi.org/10.1007/s00383-019-04549-3

    Article  PubMed  Google Scholar 

  41. Gurusamy R, Raj SV, Maniam R, Regunandan SR (2017) Laparoscopic-assisted anorectoplasty: a single-center experience. J Indian Assoc Pediatr Surg 22:114–118. https://doi.org/10.4103/jiaps.JIAPS_266_16

    Article  PubMed  PubMed Central  Google Scholar 

  42. Li S, Liu Y, Chang X, Li K, Yang D, Zhang X, Yang L, Pu J, Cao G, Tang ST (2019) Two-staged versus three-staged laparoscopic anorectoplasty for patients with rectoprostatic and bladder neck fistulas: a comparative study. J Laparoendosc Adv Surg Tech A 29:1486–1491. https://doi.org/10.1089/lap.2019.0020

    Article  PubMed  Google Scholar 

  43. Stephens FD, Smith ED, Paoul NW. New York, NY: Liss, 1988

  44. Holschneider A, Hutson J, Peña A et al (2005) Preliminary report on the International Conference for the development of standards for the treatment of anorectal malformations. J Pediatr Surg 40:1521–1526

    Article  Google Scholar 

  45. Koga H, Okazaki T, Yamataka A, Kobayashi H, Yanai T, Lane GJ, Miyano T (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 

  46. Peña A, Amroch D, Baeza C, Csury L, Rodriguez G (1993) 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  PubMed  Google Scholar 

  47. Uchida H, Iwanaka T, Kitano Y, Kudou S, Ishimaru T, Yotsumoto K, Gotoh C, Yoshida M (2009) Residual fistula after laparoscopically assisted anorectoplasty: is it a rare problem? J Pediatr Surg 44:278–281. https://doi.org/10.1016/j.jpedsurg.2008.10.056

    Article  PubMed  Google Scholar 

  48. Rentea RM, Halleran DR, Vilanova-Sanchez A et al (2019) Diagnosis and management of a remnant of the original fistula (ROOF) in males following surgery for anorectal malformations. J Pediatr Surg 54:1988–1992. https://doi.org/10.1016/j.jpedsurg.2019.02.006

    Article  PubMed  Google Scholar 

  49. Alam S, Lawal TA, Peña A, Sheldon C, Levitt MA (2011) Acquired posterior urethral diverticulum following surgery for anorectal malformations. J Pediatr Surg 46:1231–1235. https://doi.org/10.1016/j.jpedsurg.2011.03.061

    Article  PubMed  Google Scholar 

  50. Peña A, Hong AR, Midulla P, Levitt M (2003) Reoperative surgery for anorectal anomalies. Semin Pediatr Surg 12:118–123. https://doi.org/10.1016/s1055-8586(02)00022-7

    Article  PubMed  Google Scholar 

  51. Hong YK, Onal B, Diamond DA, Retik AB, Cendron M, Nguyen HT (2011) Robot-assisted laparoscopic excision of symptomatic retrovesical cysts in boys and young adults. J Urol 186:2372–2378. https://doi.org/10.1016/j.juro.2011.07.113

    Article  PubMed  Google Scholar 

  52. Takazawa S, Uchida H, Kawashima H, Tanaka Y, Masuko T, Deie K, Amano H, Kobayashi K, Tada M, Iwanaka T (2014) Urethroscopic holmium: YAG laser ablation for acquired posterior urethral diverticulum after repair of anorectal malformations. Pediatr Surg Int 30:945–949. https://doi.org/10.1007/s00383-014-3569-8

    Article  PubMed  Google Scholar 

  53. Belizon A, Levitt M, Shoshany G, Rodriguez G, Peña A (2005) Rectal prolapse following posterior sagittal anorectoplasty for anorectal malformations. J Pediatr Surg 40:192–196. https://doi.org/10.1016/j.jpedsurg.2004.09.035

    Article  PubMed  Google Scholar 

  54. Holbrook C, Misra D, Zaparackaite I, Cleeve S (2017) Post-operative strictures in anorectal malformation: trends over 15 years. Pediatr Surg Int 33:869–873. https://doi.org/10.1007/s00383-017-4111-6

    Article  PubMed  Google Scholar 

  55. Peña 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  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Basni Industrial Area, MIA, 2nd Phase, Basni, Jodhpur, 342005, India

    Manish Pathak

  2. Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, London, UK

    Amulya K. Saxena

Authors
  1. Manish Pathak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amulya K. Saxena
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manish Pathak.

Ethics declarations

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pathak, M., Saxena, A.K. Postoperative “complications" following laparoscopic-assisted anorectoplasty: A systematic review. Pediatr Surg Int 36, 1299–1307 (2020). https://doi.org/10.1007/s00383-020-04748-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-020-04748-3

Keywords

Search

Navigation