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Evaluation of defecative function 5 years or longer after laparoscopic-assisted pull-through for imperforate anus
Kenneth K Y Wong1, Xuanzhao Wu, Ivy H Y Chan
1Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong. kkywong@hku.hk
Laparoscopic anorectoplasty (LAR) shows satisfactory mid- to long-term defecative function for imperforate anus patients. Outcomes are comparable to posterior sagittal anorectoplasty (PSARP), suggesting LAR is a viable surgical option.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Surgical Outcomes Research
Background:
- Laparoscopic anorectoplasty (LAR) introduced in 2000 lacks universal acceptance.
- Early outcomes of LAR appear favorable compared to posterior sagittal anorectoplasty (PSARP).
- Mid- to long-term functional data for LAR are limited.
Purpose of the Study:
- To evaluate the mid- to long-term defecative function in patients undergoing LAR.
- To compare functional outcomes of LAR with historical PSARP controls.
- To assess the efficacy and safety of LAR for high-/intermediate-type imperforate anus.
Main Methods:
- Retrospective study of 18 patients who underwent LAR for high-/intermediate-type imperforate anus (2001-2005).
- Comparison with 20 historical PSARP controls.
- Continence assessed using Krickenbeck classification; statistical analysis via chi-squared test.
Main Results:
- 16/18 LAR patients reported positive defecation sensation versus 16/20 PSARP patients.
- 8 LAR patients achieved complete continence (no soiling/incontinence) compared to 11/20 PSARP patients.
- Constipation rates were lower in LAR (3/18) than PSARP (7/20); no significant differences in functional outcomes (P > .05).
Conclusions:
- Laparoscopic anorectoplasty (LAR) demonstrates satisfactory mid- to long-term defecative function for imperforate anus.
- Functional outcomes of LAR are comparable to posterior sagittal anorectoplasty (PSARP).
- Further long-term studies with larger cohorts are needed to confirm LAR's advantages.
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