A unique opportunity for the operative treatment of high anorectal malformations: laparoscopy

Abstract

Background/purpose: Georgeson et al. have reported a new operative technique for the treatment of high anorectal malformations (ARM) instead of posterior sagittal anorectoplasty (PSARP). With this new operative technique, anorectal pull-through is performed without a posterior sagittal incision with laparoscopic assistance. Herein we report our experience with laparoscopy-assisted anorectal pull-through (LAARP).

Methods: The hospital and the digital video records of 4 high ARM male patients who underwent LAARP between January 2002 and June 2004 were evaluated retrospectively. The LAARP procedure was accomplished as described by Georgeson et al. Dilatation of the neoanus was started on the 15th postoperative day and was continued twice daily until the desired anal diameter had been reached. The colostomies were closed thereafter.

Results: LAARP was performed in the presence of colostomy in four patients. The first two patients are passing stools two or three times a day. A bowel management program has been initiated for the third patient, who is 4 years old. The last patient still has a colostomy.

Conclusions: The laparoscopically excellent visualization of the pelvic musculature, especially of the pubococcygeal muscles, provides a great opportunity for accurate placement of the rectum in its anatomically precise place, without dividing the sphincteric muscle complex. Although there is not enough data regarding fecal continence after LAARP, we think that LAARP provides a unique opportunity for the operative treatment of high ARM and should be the first choice procedure for the operative treatment of high ARM.