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Chi Y, Chen W, Ming A, Hao X, Gao R, Li S, Ye S, Zhou Y, Li L. Transurachal Catheter for Management of Difficult Catheterization in Anorectal Malformations: A Novel Technique. J Pediatr Surg 2024:S0022-3468(24)00070-8. [PMID: 38403490 DOI: 10.1016/j.jpedsurg.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Urinary tract drainage is necessary to facilitate the maneuver in laparoscopic-assisted anorectoplasty (LAARP). Male patients with Anorectal malformations (ARM) are often encounter difficult catheterization during surgery. OBJECTIVE We pioneered the urinary catheterization through the urachus in ARM patients and evaluated the efficacy. METHOD Fourteen ARM patients undergoing urinary catheterization through urachus between September 2015 and September 2023 were reviewed. RESULTS The median age at the time of surgery was 0.06 months. Nine neonatal patients underwent the one-stage LAARP, while five patients underwent staged procedure. Four ARM patients with rectoprostatic fistula, while ten with rectobulbar fistula. All patients successfully underwent transurachal catheterization. No incidents of catheter blockage, accidental removal, or urinary tract infection symptoms were detected during hospitalization. CONCLUSIONS Transurachal catheterization is a safe, effective, and cosmetic procedure for ARM patients with difficulty urethral catheterization. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yidi Chi
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wei Chen
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Anxiao Ming
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Xianhua Hao
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ruyue Gao
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Siqi Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Shiru Ye
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Yan Zhou
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Long Li
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
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Diao M, Li L, Ming AX, Yang CZ, Xie XH, Cheng W. Efficacy of Laparoscopic Management of Posterior Urethral Diverticulum in Anorectal Malformations. Eur Urol 2023; 83:55-61. [PMID: 36058802 DOI: 10.1016/j.eururo.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/27/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND A posterior urethral diverticulum (PUD) is a serious postoperative complication after anorectal malformation correction. Complete resection is technical demanding because of limited retrourethral working space deep in the pelvis. OBJECTIVE We pioneered the single-incision laparoscopic approach for PUD excision and evaluated the efficacy. DESIGN, SETTING, AND PARTICIPANTS Twenty-six PUD patients undergoing redo surgeries between June 2011 and June 2021 were reviewed. SURGICAL PROCEDURE A series of transabdominal retraction sutures were placed through the PUD to facilitate dissection. The contents were evacuated to create a working space. Distal PUD dissection was carried along the submucosal layer to prevent injury of the urethra/pelvic nerve complex. The rectal mucosa was peeled off from the junction site for complete PUD excision. The muscular cuff of the distal rectum was then oversewn. MEASUREMENTS Operative time, postoperative recovery, and complications were assessed. RESULTS AND LIMITATIONS The mean age of redo surgery was 2.46 yr. The average operative duration was 2.35 h. The mean postoperative hospital stay, resumption of full diet, and bowel movement were 10.23, 2.15, and 1.54 d, respectively. The median follow-up period was 46 mo (12-132 mo). No remnant of PUD, recurrent fistula, or urinary leak was detected. None of the patients had difficulty in urination, urinary dribbling, urinary tract infection, constipation, or soiling. All patients retained morning erection, and two postpubertal patients had ejaculations. CONCLUSIONS Our single-incision laparoscopic redo surgery provides an effective approach for PUD excision. It minimizes complications. It also preserves urinary and bowel continence and sexual function. PATIENT SUMMARY Complete resection of a posterior urethral diverticulum (PUD) in anorectal malformation is technically demanding because of limited retrourethral working space in the deep pelvis. The outcomes of single-incision laparoscopic PUD excision were satisfactory.
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Affiliation(s)
- Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, PR China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, PR China; Beijing Tsinghua Changgung Hospital, Beijing, PR China.
| | - An-Xiao Ming
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, PR China
| | - Chang-Zhen Yang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, PR China
| | - Xiang-Hui Xie
- Department of Pediatric Urology, Capital Institute of Pediatrics, Beijing, PR China.
| | - Wei Cheng
- Chiron Healthcare Group, Hong Kong; Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
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3
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Eeftinck Schattenkerk LD, Musters GD, Nijssen DJ, de Jonge WJ, de Vries R, van Heurn LWE, Derikx JPM. The incidence of abdominal surgical site infections after abdominal birth defects surgery in infants: A systematic review with meta-analysis. J Pediatr Surg 2021; 56:1547-1554. [PMID: 33485614 DOI: 10.1016/j.jpedsurg.2021.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Surgical site infections (SSI) are a frequent and significant problem understudied in infants operated for abdominal birth defects. Different forms of SSIs exist, namely wound infection, wound dehiscence, anastomotic leakage, post-operative peritonitis and fistula development. These complications can extend hospital stay, surge medical costs and increase mortality. If the incidence was known, it would provide context for clinical decision making and aid future research. Therefore, this review aims to aggregate the available literature on the incidence of different SSIs forms in infants who needed surgery for abdominal birth defects. METHOD The electronic databases Pubmed, EMBASE, and Cochrane library were searched in February 2020. Studies describing infectious complications in infants (under three years of age) were considered eligible. Primary outcome was the incidence of SSIs in infants. SSIs were categorized in wound infection, wound dehiscence, anastomotic leakage, postoperative peritonitis, and fistula development. Secondary outcome was the incidence of different forms of SSIs depending on the type of birth defect. Meta-analysis was performed pooling reported incidences in total and per birth defect separately. RESULTS 154 studies, representing 11,786 patients were included. The overall pooled percentage of wound infections after abdominal birth defect surgery was 6% (95%-CI:0.05-0.07) ranging from 1% (95% CI:0.00-0.05) for choledochal cyst surgery to 10% (95%-CI:0.06-0.15) after gastroschisis surgery. Wound dehiscence occurred in 4% (95%-CI:0.03-0.07) of the infants, ranging from 1% (95%-CI:0.00-0.03) after surgery for duodenal obstruction to 6% (95%-CI:0.04-0.08) after surgery for gastroschisis. Anastomotic leakage had an overall pooled percentage of 3% (95%-CI:0.02-0.05), ranging from 1% (95%-CI:0.00-0.04) after surgery for duodenal obstruction to 14% (95% CI:0.06-0.27) after colon atresia surgery. Postoperative peritonitis and fistula development could not be specified per birth defect and had an overall pooled percentage of 3% (95%-CI:0.01-0.09) and 2% (95%-CI:0.01-0.04). CONCLUSIONS This review has systematically shown that SSIs are common after correction for abdominal birth defects and that the distribution of SSI differs between birth defects.
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Affiliation(s)
- Laurens D Eeftinck Schattenkerk
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Gijsbert D Musters
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands
| | - David J Nijssen
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands
| | - Wouter J de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - L W Ernest van Heurn
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joep P M Derikx
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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4
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Eeftinck Schattenkerk LD, Musters GD, Nijssen DJ, de Jonge WJ, de Vries R, van Heurn LE, Derikx JP. The incidence of different forms of ileus following surgery for abdominal birth defects in infants: a systematic review with a meta-analysis method. Innov Surg Sci 2021; 6:127-150. [PMID: 35937853 PMCID: PMC9294340 DOI: 10.1515/iss-2020-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/06/2021] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Ileus following surgery can arise in different forms namely as paralytic ileus, adhesive small bowel obstruction or as anastomotic stenosis. The incidences of these different forms of ileus are not well known after abdominal birth defect surgery in infants. Therefore, this review aims to estimate the incidence in general between abdominal birth defects.
Content
Studies reporting on paralytic ileus, adhesive small bowel obstruction or anastomotic stenosis were considered eligible. PubMed and Embase were searched and risk of bias was assessed. Primary outcome was the incidence of complications. A meta-analysis was performed to pool the reported incidences in total and per birth defect separately.
Summary
This study represents a total of 11,617 patients described in 152 studies of which 86 (56%) had a follow-up of at least half a year. Pooled proportions were calculated as follows; paralytic ileus: 0.07 (95%-CI, 0.05–0.11; I
2=71%, p≤0.01) ranging from 0.14 (95% CI: 0.08–0.23) in gastroschisis to 0.05 (95%-CI: 0.02–0.13) in omphalocele. Adhesive small bowel obstruction: 0.06 (95%-CI: 0.05–0.07; I
2=74%, p≤0.01) ranging from 0.11 (95% CI: 0.06–0.19) in malrotation to 0.03 (95% CI: 0.02–0.06) in anorectal malformations. Anastomotic stenosis after a month 0.04 (95%-CI: 0.03–0.06; I
2=59%, p=0.30) ranging from 0.08 (95% CI: 0.04–0.14) in gastroschisis to 0.02 (95% CI: 0.01–0.04) in duodenal obstruction. Anastomotic stenosis within a month 0.03 (95%-CI 0.01–0.10; I
2=81%, p=0.02) was reviewed without separate analysis per birth defect.
Outlook
This review is the first to aggregate the known literature in order approximate the incidence of different forms of ileus for different abdominal birth defects. We showed these complications are common and the distribution varies between birth defects. Knowing which birth defects are most at risk can aid clinicians in taking prompt action, such as nasogastric tube placement, when an ileus is suspected. Future research should focus on the identification of risk factors and preventative measures. The incidences provided by this review can be used in those studies as a starting point for sample size calculations.
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Affiliation(s)
- Laurens D. Eeftinck Schattenkerk
- Department of Paediatric Surgery , Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam , Amsterdam , Netherlands
| | - Gijsbert D. Musters
- Department of Paediatric Surgery , Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , Netherlands
| | - David J. Nijssen
- Department of Paediatric Surgery , Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , Netherlands
| | - Wouter J. de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam , Amsterdam , Netherlands
- Department of General, Visceral-, Thoracic and Vascular Surgery , University Hospital Bonn , Bonn , Germany
| | - Ralph de Vries
- Medical Library, Vrije Universiteit , Amsterdam , Netherlands
| | - L.W. Ernest van Heurn
- Department of Paediatric Surgery , Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam , Amsterdam , Netherlands
| | - Joep P.M. Derikx
- Department of Paediatric Surgery , Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam , Amsterdam , Netherlands
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5
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Ishimaru T, Kawashima H, Hayashi K, Omata K, Sanmoto Y, Inoue M. Laparoscopically assisted anorectoplasty-Surgical procedures and outcomes: A literature review. Asian J Endosc Surg 2021; 14:335-345. [PMID: 33029900 DOI: 10.1111/ases.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Accepted: 09/22/2020] [Indexed: 11/27/2022]
Abstract
Anorectal malformation includes various types of anomalies. The goal of definitive surgery is achievement of fecal continence. Twenty years have passed since laparoscopically assisted anorectoplasty (LAARP) was reported by Georgeson. Since LAARP is gaining popularity, its long-term outcomes should be evaluated. Presently, there is no evidence regarding the optimal method of ligating and dividing the fistula correctly and creating the pull-through canal accurately. Rectal prolapse and remnant of the original fistula (ROOF) tend to develop more often in LAARP patients than in posterior sagittal anorectoplasty (PSARP) patients; however, robust evidence is not available. Prolapse may be prevented by suture fixation of the rectum to the presacral fascia; however, if prolapse occurs, the indication, timing, and the best method for surgical correction remain unclear. Most patients with ROOF are asymptomatic, and there is controversy regarding the indications for ROOF resection. This article aimed to detail the various modifications of the LAARP procedures reported previously and to describe the surgical outcomes, particularly focusing on rectal prolapse, ROOF, and fecal continence, by reviewing the literature. Functional outcomes after LAARP were almost similar to those noted after PSARP, and we have demonstrated that LAARP is not inferior to PSARP with respect to fecal continence. Although there is controversy regarding the application of LAARP for recto-bulbar cases, we believe that LAARP is still evolving, and we can achieve better outcomes by improving the procedure.
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Affiliation(s)
- Tetsuya Ishimaru
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kentaro Hayashi
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kanako Omata
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yohei Sanmoto
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Maho Inoue
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
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A novel combined enteroscopy and laparoscopy approach to prevent urethral complications in management of rectourethral fistula. Surg Endosc 2021; 35:1921-1926. [PMID: 33523272 DOI: 10.1007/s00464-020-08268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND For the last 20 years, laparoscopy management of anorectal malformations (ARM) has been challenged due to the development of postoperative urethral diverticulum or injury caused by the imprecise transection of rectourethral fistulae, particularly rectobulbar fistulae situated deep in the pelvis. We have developed a combined approach of enteroscopy and laparoscopy for intraluminal incision of a rectourethral fistula. METHODS We retrospectively reviewed 47 ARM patients who underwent surgical corrections using the combined approach between January 2019 and June 2020. Early postoperative and subsequent follow-up results were evaluated. RESULTS The median follow-up period was 12 months. The average age at surgery was 3.18 ± 0.64 months. The mean operative time of a single-incision laparoscopic-assisted anorectoplasty (SILAARP) was 1.19 ± 0.29 h. The time for intraluminal incision of the fistula was shortened from 14 to 2 min. No patients underwent a conversion. The average postoperative hospital stay, time to full feeds and placement of an anal tube were 10 days, 1 day, and 5 days, respectively. No urethral diverticulum, urinary injury, wound infection, rectal retraction, anal stenosis or rectal prolapse was encountered in the cohort. CONCLUSIONS The combined enteroscopy and laparoscopy approach offers precise management of rectourethral fistulae. It could effectively obviate urethral complications, eliminating the obstacles of laparoscopy application in the management of ARMs.
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Ishimaru T, Hosokawa T, Kawashima H, Hayashi K, Takayama S, Omata K, Sanmoto Y, Gohara T. Rectal Prolapse After Laparoscopically Assisted Anorectoplasty for Anorectal Malformations. J Laparoendosc Adv Surg Tech A 2020; 30:1277-1281. [PMID: 33085916 DOI: 10.1089/lap.2020.0609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: To clarify the characteristics of patients with rectal prolapse after laparoscopically assisted anorectoplasty (LAARP), estimate the causes, and evaluate its impact on postoperative bowel function. Methods: The medical records of patients who underwent LAARP for high- or intermediate-type anorectal malformation between 2000 and 2019 were retrospectively reviewed. Clinical data were compared between patients with (Group P) and without prolapse (normal, Group N). Fecal continence was evaluated using the clinical assessment score for fecal continence developed by the Japanese Study Group of Anorectal Anomalies. For patients who underwent pelvic magnetic resonance imaging (MRI) before LAARP, atrophy, or asymmetry of the anal sphincter and levator ani was evaluated by a radiologist. Results: Of the 49 patients, 29 (59%) had rectal prolapse after LAARP (Group P) and 20 did not (Group N). We found no significant difference in gender, type of malformations, incidence of associated spinal or lumbosacral anomalies, procedure time, and postoperative bowel function at ages 4, 8, 12, and 16 years. However, LAARP was performed significantly earlier in Group N (median [range], 180 [123-498] days) than in Group P (210 [141-570] days). In Group P, 18 patients (62%) developed prolapse before colostomy takedown. Eight of 26 patients who underwent surgical prolapse repair required redo procedures. Twenty-five patients who underwent preoperative pelvic MRI showed no significant relationship between the muscular abnormalities and the incidence of postoperative rectal prolapse. Conclusions: Although recurrence is common, performing LAARP at a younger age might prevent postoperative prolapse development.
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Affiliation(s)
- Tetsuya Ishimaru
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Takahiro Hosokawa
- Division of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kentaro Hayashi
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Shohei Takayama
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kanako Omata
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yohei Sanmoto
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Takumi Gohara
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
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8
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Li Q, Zhang Z, Jiang Q, Yan Y, Xiao P, Ma Y, Li L. Laparoscopic-Assisted Anorectal Pull-Through for Currarino Syndrome. J Laparoendosc Adv Surg Tech A 2020; 30:826-833. [PMID: 32302513 DOI: 10.1089/lap.2019.0779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Currarino syndrome (CS) is characterized by the triad of sacral anomalies, presacral tumor, and anorectal malformation (ARM). This study evaluates the feasibility and outcomes of laparoscopic-assisted anorectal pull-through (LAARP) for CS. Materials and Methods: Children admitted for primary or redo repair of CS through LAARP between 2016 and 2019 were reviewed. The indication of redo included constipation with megarectosigmoid, residual presacral mass, anastomosis leak, and secondary fistula. ARM was corrected by excision of rectal stenosis, fistula, and its associated megarectosigmoid. This was followed by a complete surgical resection of the presacral tumor, with subsequent pull-through and anocolic anastomosis. This was done with a combined laparoscopic and transanal approach. The detailed surgical techniques, early postoperative complications, and mid-term functional outcomes were summarized. Results: Fourteen patients underwent LAARP for primary (N = 4) and redo (N = 10) repair of CS. Four of them had colostomy previously. Mean age at operation was 20.7 ± 13.9 months. Mean operative time was 120 ± 25 minutes. Median hospital stay was 8 days (range 7-9 days) postoperatively. None of the patients developed early postoperative complications such as anastomotic leaks, presacral abscesses, recurrent fistulas, and residual mass. Bowel function was assessed 1 year after LAARP in 10 patients. Mean follow-up time was 15.9 months. The frequency of bowel movements was 3.3 ± 1.5/day. Constipation occurred in 2 patients. Occasional soiling (<3 times/week) was reported in 4 patients and frequent soiling (>3 times/week) was in 1. Conclusion: LAARP for CS is safe and effective.
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Affiliation(s)
- Qi Li
- Department of General Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Zhen Zhang
- Department of General Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Qian Jiang
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing, China
| | - Yuchun Yan
- Department of Radiology, Capital Institute of Pediatrics, Beijing, China
| | - Ping Xiao
- Department of Pathology, Capital Institute of Pediatrics, Beijing, China
| | - Ya Ma
- Department of Ultrasound, Capital Institute of Pediatrics, Beijing, China
| | - Long Li
- Department of General Surgery, Capital Institute of Pediatrics, Beijing, China
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9
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Ren X, Xu H, Jiang Q, Diao M, Li X, Li L. Single-incision laparoscopic-assisted anorectoplasty for treating children with intermediate-type anorectal malformations and rectobulbar fistula: a comparative study. Pediatr Surg Int 2019; 35:1255-1263. [PMID: 31494699 DOI: 10.1007/s00383-019-04549-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Single-incision laparoscopic-assisted anorectoplasty (SILAARP) was compared to posterior sagittal anorectoplasty (PSARP) for treating intermediate-type anorectal malformations (ARMs) with rectobulbar fistula. METHODS Between December 2011 and January 2016, 48 children with intermediate-type ARMS were treated with SILAARP (n = 34) or PSARP (n = 14) in our centre. Data including demographics, complications, and long-term outcomes were retrospectively compared. RESULTS No significant difference was observed between both groups in terms of median operative time and complications. The length of postoperative hospital stay was shorter in the SILAARP group than in the PSARP group (6.15 ± 1.10 vs 9.64 ± 4.13 days; p = 0.008). After a mean follow-up of 59.38 ± 13.68 months, the rates of voluntary bowel movements, soiling, and constipation were similar in both groups. Anorectal manometry was performed in 15 and 7 children from the SILAARP and PSARP groups, respectively. Although there were no significant differences in the presence of rectoanal relaxation reflex and high-pressure-zone length, anal canal resting pressure was higher in the SILAARP group than in the PSARP group (33.35 ± 12.95 vs 23.06 ± 8.40 mmHg; p = 0.039). CONCLUSIONS Both SILAARP and PSARP seemed feasible and effective for treating intermediate-type ARMs with rectobulbar fistula in children. However, SILAARP significantly reduced the length of postoperative hospital stay and improved anal canal resting pressure.
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Affiliation(s)
- Xianghai Ren
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.,Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Hang Xu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Qi Jiang
- Department of Pathology and Pathophysiology, Hubei Provincial Key Laboratory of Developmentally Originated Disease, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Xu Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Long Li
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China. .,Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, People's Republic of China.
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10
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Diao M, Cheng W, Tam PKH, Li L. Development of pediatric minimally invasive surgery in mainland China. J Pediatr Surg 2019; 54:229-233. [PMID: 30528206 DOI: 10.1016/j.jpedsurg.2018.10.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/30/2018] [Indexed: 12/28/2022]
Abstract
Pediatric laparoscopic surgery has developed rapidly in the past 20 years in mainland China with the help of international collaborative training programs. High-volume laparoscopic workload has enabled Chinese pediatric surgeons to innovate and gain experience within a short span of time. We feel that outcomes are comparable or even in some cases superior to that of open surgery. In this article, based on the Storz Lecture to the 65th BAPS Congress in Liverpool, we share our experience of this rapid development of pediatric laparoscopy. EVIDENCE LEVEL: V.
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Affiliation(s)
- Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, PR China
| | - Wei Cheng
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, PR China; Department of Paediatrics and Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Surgery, Beijing United Family Hospital, China
| | - Paul Kwong Hang Tam
- Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR.
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, PR China.
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Xiao H, Huang R, Cui X, Chen L, Diao M, Li L. Single-Incision Laparoscopic Versus Conventional Laparoscopic Surgery for Rectobladderneck and Rectoprostatic Anorectal Malformations. J Laparoendosc Adv Surg Tech A 2018; 28:1553-1557. [DOI: 10.1089/lap.2018.0260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hui Xiao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Rui Huang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Xiaodai Cui
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Long Chen
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
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Xiao H, Chen L, Ren XH, Huang R, Diao M, Li L. One-Stage Laparoscopic-Assisted Anorectoplasty for Neonates with Anorectal Malformation and Recto-Prostatic or Recto-Bulbar Fistula According to the Krickenbeck Classification. J Laparoendosc Adv Surg Tech A 2018; 28:1029-1034. [PMID: 29741982 DOI: 10.1089/lap.2017.0690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Congenital recto-urethral fistula (RUF) is the most common form of anorectal malformations (ARMs) found in boys. The aim of this study is to review our experience with one-stage laparoscopic procedure in the management of ARMs with recto-prostatic fistula and recto-bulbar fistula. METHODS Seventeen boys with congenital RUF who underwent one-stage laparoscopy-assisted anorectoplasty (LAARP) between July 2012 and June 2015 were retrospectively in the study. RESULTS All patients successfully underwent one-staged laparoscopic surgery without conversion. The recto-prostatic urethral fistula was encountered in 6 patients and recto-urethral bulbar fistula in 11 patients. The mean age at the time of surgery was 46.2 hours with mean length of hospital stay being 10.6 days. The operative times for the recto-urethral prostatic fistula and recto-urethral bulbar fistula were similar (128.2 versus 122.4 minutes, P = .091). Intraoperative blood loss was minimal. No injury to the urethra or vas deferens. The urethral catheter was removed on postoperative day 10. No one lost to follow-up. The median follow-up period was 2.6 years (range: 2-4 years). No recurrent fistula or urethral diverticulum was detected according to the voiding cystourethrography and pelvic MRI at 1 year. CONCLUSION One-stage LAARP is safe and effective for neonates with recto-prostatic fistula and recto-bulbar fistula. It provides an alternative method to rectify the ARMs with recto-prostatic fistula and recto-bulbar fistula without colostomy.
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Affiliation(s)
- Hui Xiao
- 1 Department of Pediatric Surgery, Capital Institute of Pediatrics , Beijing, People's Republic of China .,2 Graduate School of Peking Union Medical College , Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Long Chen
- 1 Department of Pediatric Surgery, Capital Institute of Pediatrics , Beijing, People's Republic of China .,2 Graduate School of Peking Union Medical College , Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiang-Hai Ren
- 1 Department of Pediatric Surgery, Capital Institute of Pediatrics , Beijing, People's Republic of China .,2 Graduate School of Peking Union Medical College , Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Rui Huang
- 1 Department of Pediatric Surgery, Capital Institute of Pediatrics , Beijing, People's Republic of China
| | - Mei Diao
- 1 Department of Pediatric Surgery, Capital Institute of Pediatrics , Beijing, People's Republic of China
| | - Long Li
- 1 Department of Pediatric Surgery, Capital Institute of Pediatrics , Beijing, People's Republic of China
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Diao M, Li L, Guan KP, Zhang Z, Cheng W. A novel laparoscopic technique for anorectal malformation with low recto-bulbar fistulae. Surg Endosc 2017; 31:4326-4330. [DOI: 10.1007/s00464-017-5483-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 02/16/2017] [Indexed: 01/20/2023]
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Wang C, Diao M, Li L, Liu S, Chen Z, Li X, Cheng W. Laparoscopic dissection and division of distal fistula in boys with rectourethral fistula. J Surg Res 2016; 211:147-153. [PMID: 28501111 DOI: 10.1016/j.jss.2016.11.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Congenital rectourethral fistula (RUF) is the most common form of anorectal malformations found in boys. The aim of this study is to review our experience with dissection and division of distal fistula using laparoscopic surgery in the management of RUF, especially rectourethral bulbar fistula. METHODS One hundred and two consecutive boys with congenital RUF who underwent conventional or single-incision laparoscopic surgery between July 2008 and June 2015 were enrolled in the study. The dissection of the distal fistula was performed along submucosal layer to a level 0.5 cm proximal to the urethra. Rectal mucosa of the fistula was dissected to the distal most point and completely transected flush with the posterior urethra. The residual muscular cuff was ligated with Hem-o-Lock clip or 5-0 PDS suture. Voiding cystourethrography and pelvic magnetic resonance imaging were performed at 3 mo, 6 mo, and 1 y postoperatively. RESULTS All patients successfully underwent laparoscopic surgery without conversion. The mean age at the time of operation was 4.3 ± 2.9 mo. The operative times for the rectoprostatic fistula and rectobulbar fistula were similar (118.2 versus 119.4 min, P = 0.082). There was no significant difference in average operative time between conventional laparoscopic surgery group and single-incision laparoscopic surgery group (118.8 versus 119.1 min, P = 0.281). There was no injury to the urethra or vas deferens. The urethral catheter was removed on postoperative day 10. All patients were followed up. The median follow-up period was 3.3 ± 1.8 y. No recurrent fistula or urethral diverticulum was detected on voiding cystourethrography and pelvic MRI at 1 y. CONCLUSIONS Submucosal dissection and division of distal fistula using a laparoscopic approach is safe, feasible, and effective for congenital RUF, especially bulbar fistula, in boys.
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Affiliation(s)
- Chen Wang
- Department of Colorectum Surgery, Qingdao Municipal Hospital, Qingdao, People's Republic of China; Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
| | - Shuli Liu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Zheng Chen
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Xu Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Wei Cheng
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China; Department of Surgery, United Family Hospital, Beijing, China; Department of Pediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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Bandi AS, Bradshaw CJ, Giuliani S. Advances in minimally invasive neonatal colorectal surgery. World J Gastrointest Surg 2016; 8:670-678. [PMID: 27830038 PMCID: PMC5081548 DOI: 10.4240/wjgs.v8.i10.670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/27/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
Over the last two decades, advances in laparoscopic surgery and minimally invasive techniques have transformed the operative management of neonatal colorectal surgery for conditions such as anorectal malformations (ARMs) and Hirschsprung’s disease. Evolution of surgical care has mainly occurred due to the use of laparoscopy, as opposed to a laparotomy, for intra-abdominal procedures and the development of trans-anal techniques. This review describes these advances and outlines the main minimally invasive techniques currently used for management of ARMs and Hirschsprung’s disease. There does still remain significant variation in the procedures used and this review aims to report the current literature comparing techniques with an emphasis on the short- and long-term clinical outcomes.
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Wang C, Li L, Diao M, Liu S, Zhang J, Chen Z, Li X, Cheng W. Single-Incision Laparoscopic-Assisted Anorectoplasty for the Management of Persistent Cloaca. J Laparoendosc Adv Surg Tech A 2016; 26:328-33. [DOI: 10.1089/lap.2015.0296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Chen Wang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College, Beijing, People's Republic of China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College, Beijing, People's Republic of China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Shuli Liu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Jinshan Zhang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Zheng Chen
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Xu Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Wei Cheng
- Department of Surgery, United Family Hospital, Beijing, People's Republic of China
- Departments of Pediatrics and Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Congenital anomaly rectified at birth: one-stage single-incision laparoscopic-assisted anorectoplasty for newborns with anorectal malformations and recto-urethral fistula. Surg Endosc 2016; 30:5156-5164. [PMID: 26969663 DOI: 10.1007/s00464-016-4841-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Currently, staged procedures involving stoma formation and closure are the widely accepted treatment for newborns suffering from anorectal malformations (ARM) with recto-urethral fistula. This study aims to evaluate the safety and efficacy of one-stage single-incision laparoscopic-assisted anorectoplasty (SILAARP) as an alternative to the conventional approach. METHODS Newborns with ARMs and recto-urethral fistula who underwent one-stage SILAARP between June 2013 and December 2014 were reviewed. The procedure involved decompression of the meconium via a small temporary incision of the proximal sigmoid colon followed by a laparoscopic-assisted pull-through. RESULTS Sixteen ARM newborns [recto-prostatic fistula (6), recto-bulbar fistula (10)] successfully underwent a one-stage SILAARP. The mean age of the neonates at operation was 42.1 h. The average operative time was 2.4 h. The actual pull-through took 1.7 h, which did not differ significantly from 1.9 h in the pull-through procedure of our three-stage SILAARP control group. The median follow-up period was 16 months (8-26 months). No complications were encountered. Postoperative pelvic magnetic resonance imaging verified the centrally placed rectum within the muscle complex. Most patients started having bowel movements on postoperative day 1. Two constipated patients periodically required an enema for 1-3 months. CONCLUSIONS One-stage SILAARP is safe and effective. It provides complete rectification of ARM with recto-urethral fistula immediately after birth with good cosmesis.
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Abstract
Seventeen years have passed since the first description of the laparoscopic approach for anorectal malformation and approximately 68 articles have been published on the subject. In this review article, we aim to describe the advantages as well as the indications and contraindications of this approach when dealing with each specific type of anorectal malformation, according to what has been described in the literature and to our own experience. The ideal and undisputable indication for laparoscopy remains for cases in which the abdomen needs to be entered to repair the malformation. Only 10% of male patients with anorectal malformation are born with a recto-bladder neck fistula that requires an abdominal approach, this represents an ideal indication for laparoscopy. In females, only the complex cloacae with a common channel length greater than 3 cm are the ones that require a laparotomy; they represent about 30% of the cloacae. However, the repair of this type of cloacae also requires sophisticated and technically demanding maneuvers that have never been done laparoscopically. In cases of recto-urethral prostatic fistulas the malformation can be repaired either way: laparoscopically or posterior sagitally. In all other malformations: recto-perineal fistula, recto-urethral bulbar fistula, anorectal malformation without fistula, rectal atresia, recto-vestibular fistula; no justification for laparoscopy could be found; and in some cases, laparoscopy is contraindicated. In the published reports, there is no evidence supporting the idea that laparoscopic repair results in better functional results when compared with non-laparoscopic operation; there is a tendency to omit information relevant to bowel control such as the characteristics of the sacrum and the presence or absence of tethered cord; and most authors do not compare results between comparable malformations.
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