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. 2022 May;38(5):761-768.
doi: 10.1007/s00383-022-05106-1. Epub 2022 Mar 7.

Long-term outcomes of male imperforate anus with recto-urethral fistula: laparoscopy-assisted anorectoplasty versus posterior sagittal anorectoplasty

Hiroyuki Koga  1 , Yuichiro Miyake  2 , Yuta Yazaki  2 , Takanori Ochi  2 , Shogo Seo  2 , Geoffrey J Lane  2 , Atsuyuki Yamataka  2
Affiliations

Long-term outcomes of male imperforate anus with recto-urethral fistula: laparoscopy-assisted anorectoplasty versus posterior sagittal anorectoplasty

Hiroyuki Koga et al. Pediatr Surg Int. 2022 May.

Abstract

Purpose: A five-parameter fecal continence evaluation questionnaire (FCEQ) and incidence of complications were used for long-term assessment of laparoscopy-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) for treating male imperforate anus (MIA) with rectobulbar (RB) or rectoprostatic (RP) fistulas.

Methods: Subjects were 64 consecutive Japanese MIA patients with RB or RP fistulas treated at a single institution between 1995 and 2021. FCEQ data collected retrospectively were used to calculate a fecal continence evaluation (FCE) score (best = 10) and coefficient of variation for FCE (FCECV). The statistical significance threshold was defined at p < 0.05.

Results: Fistulas were RB (n = 40; LAARP = 25/40, PSARP = 15/40) or RP (n = 24; LAARP = 17/24, PSARP = 7/24). Mean ages at surgery and status of the sacrum were similar (p = 0.06, 0.05 and 0.51). FCE scores in RP-LAARP were consistently higher with less FCECV but differences were only statistically significant from 7 years postoperatively (p < 0.05). While FCE scores for RB-LAARP and RB-PSARP were similar (p = 0.99), FCECV were lower for RB-LAARP compared with RB-PSARP. LAARP was associated with less-wound infections, but greater incidence of anal mucosal prolapse unrelated to preoperative status of the sacrum.

Conclusion: Long-term postoperative FCEQ assessment favored LAARP for treating MIA with either RB or RP fistulas.

Keywords: Imperforate anus; Laparoscopy-assisted anorectoplasty; Posterior sagittal anorectoplasty; Recto-bulbar fistula; Recto-prostatic fistula.

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