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Laparoscopic surgical technique to facilitate management of high anorectal malformations – report of seven cases

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Author(s): Andrzej Gołębiewski | Maciej Murawski | Marcin Łosin | Marek Królak | Piotr Czauderna

Journal: Videosurgery and Other Miniinvasive Techniques
ISSN 1895-4588

Volume: 6;
Issue: 3;
Start page: 150;
Date: 2011;
Original page

Keywords: laparoscopy | anorectal malformations | laparoscopically assisted anorectal pull-through (LAARP) | children

ABSTRACT
Anorectal malformations (ARMs) occur in approximately 1 per 5000 live births. The most commonly used procedurefor repair of high ARMs is posterior sagittal anorectoplasty (PSARP). This operation is performed entirely througha perineal approach. The first report of laparoscopically assisted anorectal pull-through (LAARP) for repair of ARMswas presented by Georgeson in 2000. The aim is presenting early experience with laparoscopically assisted anorectalpull-through technique in boys with high anorectal malformations. In the last 5 years 7 boys (9 months to 2 years old)with high ARMs were operated on using the LAARP technique. Laparoscopically the rectal pouch was exposed downto the urethral fistula, which was clipped and divided. Externally, the centre of the muscle complex was identifiedusing an electrical stimulator. In the first 4 patients after a midline incision of 2 cm at the planned anoplasty site,a tunnel to the pelvis was created bluntly and dilated with Hegar probes under laparoscopic control. In the last 3 boysa minimal PSARP was done creating a channel into the pelvis. The separated rectum was pulled down and sutured tothe perineum. Laparoscopic mobilization of the rectal pouch and fistula division was possible in all cases. There wereno intraoperative complications except one ureteral injury. Patients were discharged home on post-operative day 5 to7. The early results prove that LAARP, an alternative option to PSARP for treatment of imperforate anus, offers manyadvantages, including excellent visualization of the pelvic anatomical structures, accurate placement of the bowel intothe muscle complex and a minimally invasive abdominal and perineal incision. It allows for shorter hospital stay andfaster recovery. However, to compare the functional results against the standard procedure (PSARP), longer followupof all patients is necessary.
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