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Liu YS, Zhu HW, Wang Y, Ma D. Analysis of postoperative complications in children treated for moderate to severe anal atresia with laparoscopic versus open surgery: A retrospective study. Medicine (Baltimore) 2023; 102:e36744. [PMID: 38206727 PMCID: PMC10754549 DOI: 10.1097/md.0000000000036744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
This study aimed to compare and analyze the postoperative complications and anal function after 3-stage laparoscopic-assisted anorectoplasty (LAARP) and conventional posterior sagittal anorectoplasty (PSARP) in the treatment of moderate to severe anal atresia in children. A total of 27 children with moderate to severe anal atresia who underwent conventional PSARP at the Dongguan Children Hospital between 2007 and 2011 were included in the control group, and 34 children with moderate to severe anal atresia who underwent 3-stage LAARP between 2012 and 2016 were included in the observation group. The incidence of postoperative complications and Kelly score of anal function in the 2 groups were statistically analyzed and the efficacy of the 2 procedures compared. The incidence of postoperative complications such as wound infection, anal stenosis, anastomotic leakage, fecal incontinence, and constipation in the LAARP group was lower as compared with the PSARP group, and there was a statistically significant difference (P < .05). There was no significant difference in the incidence of postoperative complications such as rectal prolapse, diarrhea, and recurrent fistula between the LAARP group and the PSARP group (P > .05). The Kelly score of anal function was higher in the LAARP group than in the PSARP group, and the difference was statistically significant (P < .05). Compared to conventional PSARP, laparoscopic surgery for moderate to severe anal atresia in children has less complications, improved anal function, and a clear therapeutic impact.
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Affiliation(s)
- Ying-Song Liu
- Department of Pediatric Surgery, Dongguan Children’s Hospital, Dongguan, China
| | - Hai-Wei Zhu
- Department of Pediatric Surgery, Dongguan Children’s Hospital, Dongguan, China
| | - Yi Wang
- Department of Pediatric Surgery, Dongguan Children’s Hospital, Dongguan, China
| | - Da Ma
- Department of Pediatric Surgery, Dongguan Children’s Hospital, Dongguan, China
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Florou M, Kepertis C, Mouravas V, Anastasiadis K, Spyridakis I. Laparoscopic-Assisted Anorectoplasty for Anorectal Malformation With Recto-Prostatic Urethral Fistula: A Case Report and Review of the Literature. Cureus 2023; 15:e49008. [PMID: 38111460 PMCID: PMC10726792 DOI: 10.7759/cureus.49008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
Congenital recto-urethral fistula is the most common form of anorectal malformation found in boys. The final repair includes the ligation of the fistula and the anorectoplasty, and can be achieved either way: posterior sagitally or laparoscopically. We present a case of a term male infant diagnosed with anorectal malformation and recto-prostatic urethral fistula, that underwent a laparoscopic-assisted posterior sagittal anorectoplasty in our department.
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Affiliation(s)
- Maria Florou
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, GRC
| | | | - Vassileios Mouravas
- Department of Pediatric Surgery, General Hospital Papageorgiou, Thessaloniki, GRC
| | | | - Ioannis Spyridakis
- Department of Pediatric Surgery, General Hospital Papageorgiou, Thessaloniki, GRC
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Turchinets AI, Khmelnitskaya AV, Sulavko YP, Ionov AL, Nikolaev VV, Karachentsova IV. [Long-term results of surgical correction of H-type fistula in girls with a normal anus]. Khirurgiia (Mosk) 2021:39-45. [PMID: 33759467 DOI: 10.17116/hirurgia202104139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the long-term results of surgical correction of H-type fistula in girls with a normal anus. MATERIAL AND METHODS There were 7 patients with rectovestibular fistula and 3 patients with rectovaginal fistula with a normal anus were observed from 2014 to 2019 in the Surgical Department No. 1 of the Russian Children's Clinical Hospital. Upon admission, all patients underwent genital examination, vaginoscopy, rectal examination and probing the fistulous canal, irrigography, abdominal and retroperitoneal ultrasound. They were also examined by a gynecologist and genital smears were obtained. Surgical treatment was determined depending on the height and diameter of the fistula for each child. One patient underwent perineal fistulectomy, three patients - anterior anorectoplasty. Invaginated fistula extirpation, abdominoperineal proctoplasty and perineal fistulectomy using a pad flap between the defects were used in two cases, respectively. Patients were followed-up for the period from 6 months to 1 year after the last recurrence. Follow-up examination, irrigography and functional examination of sphincter were performed. RESULTS Two (20%) patients did not require redo surgery. In 6 (60%) cases, recurrences didn't occur within a year after the second surgery, in 2 (20%) cases - after 3 operations. Recurrent H-type fistula appeared after 3 of 4 perineal fistulectomy procedures, 3 of 9 anterior anorectoplasty, 2 of 2 abdominoperineal proctoplasty and 2 of 3 invaginated fistula extirpation. Hypotension of internal anal sphincter and neo-rectal ampulla, recurrent vulvovaginitis were diagnosed in 2 patients in 6 months after anterior anorectoplasty. CONCLUSION We recommend anterior anorectoplasty and perineal fistulectomy using a pad flap between the defects for the treatment of H-type fistula to minimize the risk of recurrence.
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Affiliation(s)
- A I Turchinets
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Khmelnitskaya
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ya P Sulavko
- Pirogov Russian National Research Medical University, Moscow, Russia.,Russian Children's Clinical Hospital, Moscow, Russia
| | - A L Ionov
- Russian Children's Clinical Hospital, Moscow, Russia
| | - V V Nikolaev
- Russian Children's Clinical Hospital, Moscow, Russia
| | - I V Karachentsova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Russian Children's Clinical Hospital, Moscow, Russia
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Apte A, McKenna E, Levitt MA. Image of the Month: How to Select the Ideal Surgical Approach in Male Anorectal Malformation with No Visible Fistula. European J Pediatr Surg Rep 2020; 8:e105-e107. [PMID: 33244450 PMCID: PMC7684987 DOI: 10.1055/s-0040-1721042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
We present a case of a 6-month-old male infant with an anorectal malformation (ARM) who underwent colostomy as a newborn, and now presents for definitive repair. A colostogram is shown to identify the malformation and to help plan for the ideal surgical approach. The case is presented with a focus on surgical strategies for management of ARM in the male infant, with questions for the readers posed in a quiz format.
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Affiliation(s)
- Anisha Apte
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
| | - Elise McKenna
- Department of General and Thoracic Surgery, Children's National Medical Center, Washington, District of Columbia, United States
| | - Marc A Levitt
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States.,Department of General and Thoracic Surgery, Children's National Medical Center, Washington, District of Columbia, United States.,Division of Colorectal and Pelvic Reconstruction Surgery, Children's National Medical Center, Washington, District of Columbia, United States
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Li S, Liu Y, Chang X, Li K, Yang D, Zhang X, Yang L, Pu J, Cao G, Tang ST. Two-Staged Versus Three-Staged Laparoscopic Anorectoplasty for Patients with Rectoprostatic and Bladder Neck Fistulas: A Comparative Study. J Laparoendosc Adv Surg Tech A 2019; 29:1486-1491. [PMID: 31486708 DOI: 10.1089/lap.2019.0020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose: To compare the results of two- versus three-staged laparoscopic anorectoplasty (LARP) in children with rectoprostatic and bladder neck fistulas. Materials and Methods: The present study was retrospectively initiated among 32 consecutive patients who underwent two-staged LARP from October 2010 to December 2012. The associated defects, age at the operation, operative time, complications, length of the postoperative hospital stay, total hospitalization cost, and functional results (according to the Krickenbeck scoring system) were evaluated. The results were compared with those of 19 cases who underwent three-staged LARP from October 2008 to September 2010. Results: The average age at the second operation was 4.5 ± 1.2 months in the two-staged group, and 4.2 ± 1.3 months in the three-staged group. In the two-staged group, there were statistically shorter overall operative time and postoperative hospital stay duration. Also, a significantly lower total hospitalization cost was achieved. There was no anastomotic leak in either group. The rates of perineal wound infection, recurrent fistula, and rectal prolapse were 3.85% versus 0% (P = 1.000), 0% versus 5.3% (P = .422), and 11.5% versus 15.8% (P = .686), respectively (two-staged versus three-staged group). The median follow-up time was 67 (range, 54-80) months and 88 (range, 81-104) months, respectively. No significant difference in functional outcome was observed. Conclusions: Two-staged LARP is feasible, safe, and more cost-effective, with comparable incidences of complications and functional outcomes with respect to a three-staged procedure.
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Affiliation(s)
- Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Liu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaopan Chang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dehua Yang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Yang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiarui Pu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoqing Cao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shao-Tao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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