Two-stage treatment for high/intermediate-type anorectal malformation through laparoscopy anorectoplasty

Abstract

Objective To explore the feasibility of two-stage operation for treating high/intermediate-type anorectal malformation (ARM) through laparoscopic anorectoplasty (LAARP). Methods From March 2010 to August 2013, 33 cases of LAARP were performed at our department. Among them, 25 patients underwent LAARP and colostomy closure simultaneously. There were 24 boys and 1 girls with an age range of 4-24 months and a weight range of 4-12.5 kg. Among 24 boys, there were rectovesical fistula (n=5) and rectourethral fistula (n=19). And the girl had no fistula. 22 colostomies were placed in transverse colon and 3 in sigmoid colon. Results The operative duration of laparoscopy were 50-140 min, including the time of of high-ligation of bilateral inguinal hernia (n=4), there were dyspastic kidney resection (n=1), appendectomy (n=1) and orchiorrhaphy (n=1). The mean blood loss volume was 20 (5-30) ml. The postoperative feeding time was 6-8 days and no stoma leaking occurred. The early complications included wound infection (n=8), pelvic infection (n=1) and rectal prolapse (n=5). During a follow-up period of 4-52 months, one patient complicated with esophageal atresia and tracheoesophageal fistula died of asphyxiation. And 22(92%) had voluntary vowel movements while another 2 could not be judged due to dysgnosia. Six (24%) patients had a varying degree of soiling and another 4 patients constipation. Malone antegrade continence enema was not required. Conclusions LAARP and colostomy closure may be performed simultaneously for select patients with high/intermediate-type ARM. However, the safety and long-term results should be further assessed by future prospective studies. Key words: Anus, imperforate; Laparoscopy; Retrospective studies