Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Mar 21;11(3):376.
doi: 10.3390/children11030376.

Short and Long-Term Outcomes of PSARP versus LAARP and Single versus Staged Repair for Infants with High-Type Anorectal Malformations: A Systematic Review and Meta-Analysis

Maria Enrica Miscia  1   2 , Giuseppe Lauriti  1   2 , Dacia Di Renzo  2 , Valentina Cascini  2 , Gabriele Lisi  1   2
Affiliations
Review

Short and Long-Term Outcomes of PSARP versus LAARP and Single versus Staged Repair for Infants with High-Type Anorectal Malformations: A Systematic Review and Meta-Analysis

Maria Enrica Miscia et al. Children (Basel). .

Abstract

Background: We aimed to compare among patients with high-type anorectal malformations (ARM): (i) short- and long-term outcomes of laparoscopic-assisted anorectoplasty (LAARP) compared to classic posterior sagittal anorectoplasty (PSARP) and (ii) the results of single-stage versus staged PSARP.

Methods: Using a defined search strategy, two independent investigators systematically reviewed the English literature. PRISMA guidelines were followed, and meta-analysis was performed using RevMan5.3.

Results: Of 567 abstracts screened, 7 papers have been included (254 pts; 121 PSARP, 133 LAARP) in the first systematic review and meta-analysis. The length of hospitalization was shortened in LAARP versus PSARP (10.9 versus 14.4 days; p < 0.0001). PSARP and LAARP were comparable in terms of early postoperative complications (28.9% versus 24.7%; p = ns) and rectal prolapse (21.6% versus 17.5%; p = ns). At long-term follow-up, the presence of voluntary bowel movements (74.0% versus 83.5%; p = ns) and the incidence of soiling (45.5% versus 47.6%; p = ns) were similar in both PSARP and LAARP. Six papers (297 pts) were included in the second systematic review, with three comparative studies included in the meta-analysis (247 pts; 117 one-stage, 130 staged procedures). No significant difference in terms of presence of voluntary bowel movements after single-stage versus staged procedures (72.6% versus 67.3%; p = ns) has been detected.

Conclusions: LAARP seems to be a safe and effective procedure, showing short- and long-term outcomes similar to PSARP. One-stage PSARP could be a safe alternative to the classic three-stage procedure, even for those infants with high-type ARM. Further and larger comparative studies would be needed to corroborate these partial existing data.

Keywords: anorectal malformations; laparoscopic-assisted procedure; meta-analysis; single-stage procedure; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Diagram of workflow in the systematic review and meta-analysis, adapted from prisma-statement.org (accessed on 31 January 2024) [17].
Figure 2
Figure 2
Forest plot comparison of length of hospitalization in the LAARP versus the PSARP groups [2,10].
Figure 3
Figure 3
Forest plot comparison of early postoperative complication in the LAARP versus the PSARP groups [1,2,3,8,9,10].
Figure 4
Figure 4
Forest plot comparison of rectal prolapse in the LAARP versus the PSARP groups [1,2,3,8,9,10].
Figure 5
Figure 5
Forest plot comparison of the presence of voluntary bowel movements in the LAARP versus the PSARP groups [1,2,3,8,10,11].
Figure 6
Figure 6
Forest plot comparison of the incidence of soiling in the LAARP versus the PSARP groups [1,8].
Figure 7
Figure 7
Forest plot comparison of the presence of voluntary bowel movements after the single stage versus staged procedures [4,7,13].
See this image and copyright information in PMC

References

    1. England R.J., Warren S.L., Bezuidenhout L., Numanoglu A., Millar A.J. Laparoscopic repair of anorectal malformations at the Red Cross War Memorial Children’s Hospital: Taking stock. J. Pediatr. Surg. 2012;47:565–570. doi: 10.1016/j.jpedsurg.2011.08.006. - DOI - PubMed
    1. Tong Q.-S., Tang S.-T., Pu J.-R., Mao Y.-Z., Wang Y., Li S.-W., Cao Q.-Q., Ruan Q.-L. Laparoscopically assisted anorectal pull-through for high imperforate anus in infants: Intermediate results. J. Pediatr. Surg. 2011;46:1578–1586. doi: 10.1016/j.jpedsurg.2011.04.059. - DOI - PubMed
    1. Kimura O., Iwai N., Sasaki Y., Tsuda T., Deguchi E., Ono S., Furukawa T. Laparoscopic versus open abdominoperineal rectoplasty for infants with high-type anorectal malformation. J. Pediatr. Surg. 2010;45:2390–2393. doi: 10.1016/j.jpedsurg.2010.08.042. - DOI - PubMed
    1. Xiao H., Huang R., Chen L. The midterm outcomes of 1-stage versus 3-stage laparoscopic-assisted anorectoplasty in anorectal malformations with rectoprostatic fistula and rectobulbar fistula: A retrospective cohort study. Medicine. 2018;97:e11843. doi: 10.1097/MD.0000000000011843. - DOI - PMC - PubMed
    1. Leva E., Macchini F., Arnoldi R., Di Cesare A., Gentilino V., Fumagalli M., Mosca F., Bhuiyan A., Torricelli M., Banu T. Single-stage surgical correction of anorectal malformation associated with rectourinary fistula in male neonates. J. Neonatal Surg. 2013;2:3. doi: 10.47338/jns.v2.15. - DOI - PMC - PubMed

LinkOut - more resources