Laparoscopically assisted anorectal pull-through for rectovestibular fistula

Abstract

Purpose Laparoscopically assisted anorectal pull-through (LAARP) has been  described as an alternative to posterior sagittal anorectoplasty for the surgical  treatment of rectourethral fistula in boys. The aim of the present study was to evaluate the feasibility, safety, efficacy, and advantages of LAARP in the repair of  rectovestibular fistula (RVF) in girls.
Patients and methods From January 2010 to January 2015, we conducted a  prospective collection of data of our patients with RVF who were treated with LAARP, regarding demographics, VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, limb malformations) screening, perioperative measurements, complications, and outcome. Anorectal function of these patients was evaluated using Kelly’s clinical score.
Results Sixteen girls with RVF underwent LAARP at our hospital. For all these girls, umbilical colostomy had been performed at the time of their birth. The mean age at LAARP operation was 3 months (range = 2–5 months). Mean operative time was 99 min. Mean hospital stay was 3.2 days. There were no intraoperative complications.  All the patients had their colostomy reversed. No patient had a stricture at the anorectal anastomosis. The mean follow-up time was 35.7 months (range = 6–60  months). The cosmetic appearance was satisfactory. Seven patients, who were older than 3 years, achieved continence and had regular bowel movements with good  Kelly’s clinical score of 6. For the remaining nine patients, the longest follow-up was 3 years, and therefore continence could not be evaluated.
Conclusion LAARP for the repair of RVF in girls is feasible, safe, and efficient. Long-term follow-up, which would remain unavailable for several years, is necessary.

Keywords: anorectal malformation, imperforated anus, laparoscopically assisted anorectoplasty, rectovestibular fistula