Title

Laparoscopic-assisted PSARP - The advantages of combining both techniques for the treatment of anorectal malformations with recto-bladderneck or high prostatic fistulas

Document Type

Journal Article

Publication Date

2-1-2013

Journal

Journal of Pediatric Surgery

Volume

48

Issue

2

DOI

10.1016/j.jpedsurg.2012.11.019

Keywords

Anorectal malformation; Bladderneck fistula; Laparoscopic repair; Prostatic fistula; PSARP

Abstract

Aim The aim of this study was to present an alternative way to use both the posterior sagittal approach combined with laparoscopy for the repair of select cases of anorectal malformation (ARM). Methods The laparoscopic approach was used for rectal dissection, ligation of the fistula, and division of vessels to pull the rectum down in cases of ARM with recto-bladderneck or high prostatic fistula. The posterior sagittal incision we believe made the perineal portion safer, allowing for rectal tapering when necessary, and for accurate placement of the rectum, anchored in the center of the sphincter. Results There were 15 children (recto-bladderneck fistula, n = 13 and recto-prostatic fistula, n = 2) in this series. There were no urethral injuries, posterior urethral diverticula, or rectal strictures. A laparotomy was needed in two children in order to mobilize a very high rectum. Follow-up ranged from 3 months to 10 years. Clinical results were consistent with our published series for male patients with these types of defects: 5 are fecally incontinent (3 are clean with a bowel management program), 1 is fecally continent, and 9 are too young to assess. Four children suffered rectal mucosal prolapse. Conclusion The combination of laparoscopy and PSARP represents a useful technical alternative that allows for a safe reconstruction in cases of ARM with recto-bladderneck and in selected high prostatic fistulas. © 2013 Elsevier Inc.

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