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. 2022 Apr 21;9(5):587.
doi: 10.3390/children9050587.

Percutaneous Anorectoplasty (PARP)-An Adaptable, Minimal-Invasive Technique for Anorectal Malformation Repair

Julia Küppers  1 , Viviane van Eckert  1 , Nadine R Muensterer  1 , Anne-Sophie Holler  1 , Stephan Rohleder  2 , Takafumi Kawano  3 , Jan Gödeke  1 , Oliver J Muensterer  1
Affiliations

Percutaneous Anorectoplasty (PARP)-An Adaptable, Minimal-Invasive Technique for Anorectal Malformation Repair

Julia Küppers et al. Children (Basel). .

Abstract

Background: Anorectal malformations comprise a broad spectrum of disease. We developed a percutaneous anorectoplasty (PARP) technique as a minimal-invasive option for repair of amenable types of lesions.

Methods: Patients who underwent PARP at five institutions from 2008 through 2021 were retrospectively analyzed. Demographic information, details of the operative procedure, and perioperative complications and outcomes were collected.

Results: A total of 10 patients underwent the PARP procedure during the study interval. Patients either had low perineal malformations or no appreciable fistula. Most procedures were guided by ultrasound, fluoroscopy, or endoscopy. Median age at PARP was 3 days (range 1 to 311) days; eight patients were male. Only one intraoperative complication occurred, prompting conversion to posterior sagittal anorectoplasty. Functional outcomes in most children were highly satisfactory in terms of continence and functionality.

Conclusions: The PARP technique is an excellent minimal-invasive alternative for boys born with perineal fistulae, as well as patients of both sexes without fistulae. The optimal type of guidance (ultrasound, fluoroscopy, or endoscopy) depends on the anatomy of the lesion and the presence of a colostomy at the time of repair.

Keywords: Down syndrome; anorectal malformation; anorectoplasty; endoscopy; fluoroscopy; keyword; percutaneous; perineal fistula; ultrasound.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Screenshot of Video S1. Typical perineal fistula with bucket-handle in a boy.
Figure 2
Figure 2
Ultrasound image during uPARP showing the guidance of the needle (arrow) towards the meconium-filled rectal pouch.
Figure 3
Figure 3
Technique of iPARP. The needle and guidewire are introduced into the rectum through the sphincter complex (a) under fluoroscopic guidance (b). A balloon dilator is advanced over the guidewire (c) to dilate the tract (d).
Figure 4
Figure 4
Screenshot of Video S2. Trans-neoanal endoscopic view of the anastomosis being con-structed.
Figure 5
Figure 5
Star-shaped end of the rectal pouch marking the future tract towards the sphincter complex (*).
See this image and copyright information in PMC

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