Publication:

Laparoscopic assisted anorectoplasty in children: a prospective study

Background Anorectal malformations are a spectrum of congenital defects that continue to represent a significant challenge for the paediatric surgeon. Development of minimally invasive surgery has probably been the biggest revolution in surgical practice in last two decades, which has gone through a period of rapid development during last 10 years; one of such changing procedure is LAARP for ARM. The aim of this study is to evaluate the clinical and functional outcomes in children with anorectal malformation treated by LAARP.

Methods From Sep.2012 to June 2014, 16 patients with intermediate and high imperforate anus underwent LAARP. Inclusion criteria were children with ARM, age >3 months, stage I sigmoid colostomy, with no associated morbid anomaly, Operative procedure followed was that given by Georgeson KE (2000).

Results 16 cases were included in this study out of which males were 87.5%. The most common ARM type was rectobulbar fistula (50%). The mean operative time was 2.75 hrs approx. and mean blood loss 24 ml approx. Conversion rate to APPT was 25%. The mean length of hospital stay was shorter (8 day’s approx). Few postoperative complications were mucosal prolapse 6.25%, stenosis 12.5%, and peritoneal contamination with faecal matter 12.5%, temporary neurogenic bladder 12.5%.

Conclusions Laparoscopically assisted anorectal pull-through has advantages, including shorter hospital stay, minimal blood loss and better functional outcome. Satisfactory rectal continence can be achieved in children with imperforate anus after LAARP. Shorter dissection of rectum in the intra-abdominal space may be helpful in preventing rectal mucosal prolapse.