Evaluation of laparoscopic-assisted anorectoplasty for the management of intermediate and high anorectal malformations in boys: Mansoura experience

Abstract

Introduction: Laparoscopic-assisted anorectoplasty (LAARP) has been gaining great popularity for management of imperforate anus. This study aims to evaluate the use of this technique for high and intermediate anorectal malformations in boys.

Patients and methods: From December 2012 to December 2016, we performed LAARP on 20 boys, all of which were colostomized at birth. Findings regarding the patients’ age at operation, type of anomaly, associated morbidities, sacral ratios, operative time, intraoperative complications, hospital stay, immediate/long-term postoperative complications, and reoperations were noted. Postoperatively, we evaluated the patients using barium enema, an ascending and voiding cystourethrogram, pelvic MRI, and a functional continence evaluation questionnaire.

Results: A total of 11 patients presented with rectourethral bulbar fistula (RBF), seven with rectourethral prostatic fistula (RPF), one with rectovesical fistula, and one with no fistula. Mean sacral ratio was 0.82 ± 0.19. Mean age at time of LAARP was 236 ± 77 days. Mean operative time was 152 ± 32 min. Our most common intraoperative complication was peritoneal contamination (20%). Incidence of rectal mucosal prolapse was 40%. Barium enema revealed a mean rectoanal angle of 107 ± 13°. Ascending and voiding cystourethrogram revealed a residual urethral diverticulum in seven cases, six of which had RBFs. Mean MRI placement score obtained was 0.76± 0.51 denoting excellent rectal position.

Conclusion: Usage of LAARP to manage high and intermediate anorectal malformations in boys is feasible, allowing accurate rectal placement within the muscle complex and with good postoperative functional results. Residual urethral diverticulum occurred more frequently in patients with RBF. Incidence of mucosal prolapse is high after LAARP and should be avoided.

Keywords: laparoscopic-assisted anorectoplasty, anorectal malformations, residual urethral diverticulum post LAARP