A novel laparoscopic technique for anorectal malformation with low recto-bulbar fistulae.

Abstract

The repair of anorectal malformation (ARM) with low recto-bulbar fistula (bowel-to-skin distance: 1-1.5cm) is contraindicated for laparoscopy due to the difficulty in exposing the fistulae. Posterior or anterior sagittal anorectoplasty is thus conventionally carried out for low recto-bulbar fistula repair. However, these procedures carry the potential risk of wound infection/dehiscence and incontinence. We have developed a single-incision laparoscopic-assisted perineal anorectoplasty (SILPARP) technique. The current study aims to evaluate the safety and efficacy of this novel procedure. Fifteen infants with ARMs and low recto-bulbar fistulae who underwent a SILPARP between November 2013 and March 2016 were reviewed. The mean distance between the rectal pouch and the perineal skin was 1.15cm. The mean age at the time of surgery was 3.92 months. The average operative time was 1.60h. All patients resumed feeding on postoperative day 1. The median follow-up duration was 7 months. No injury to blood vessels, the urethra or vas deferens was encountered in our series. No mortality, morbidity of wound infection, rectal retraction, anal stenosis, or rectal prolapse was encountered. The postoperative voiding cystourethrogram verified that there was no urethral diverticulum or recurrent fistula. Postoperative pelvic magnetic resonance imaging demonstrated that the distal rectum was located in the center of the pelvic muscle complex. SILPARP is a feasible alternative treatment for ARM infants with low recto-bulbar fistulae.