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Single-incision laparoscopic-assisted anorectoplasty using conventional instruments for children with anorectal
1Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, P. R. China.
Insights
Single-incision laparoscopic-assisted anorectoplasty (SILAARP) is a safe and effective surgical option for children with anorectal malformations (ARM) and fistulas. This one-stage procedure offers a viable alternative treatment with excellent outcomes.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Congenital Malformations
Background:
- Anorectal malformations (ARM) with rectourethral or rectovesical fistulas require effective surgical correction.
- Evaluating the safety and efficacy of single-incision laparoscopic-assisted anorectoplasty (SILAARP) for these complex pediatric cases.
Observation:
- Thirty-one pediatric patients with ARM and various fistulas underwent SILAARP.
- Operative times were comparable across different fistula types (rectobulbar vs. rectovesical/rectoprostatic).
- All patients demonstrated successful recovery, resuming feeding on postoperative day 1, with a median follow-up of 20 months.
Findings:
- SILAARP was successfully performed in all patients without requiring conversion to open surgery.
- No intraoperative injuries to critical structures (vessels, urethra, vas deferens) were reported.
- The study observed no mortality or significant postoperative morbidities, including wound infections, rectal complications, or anal stenosis.
Implications:
- SILAARP presents a safe, feasible, and effective surgical approach for pediatric ARM with rectourethral or rectovesical fistulas.
- This one-stage procedure offers a promising alternative to traditional surgical methods for treating these complex congenital anomalies.
- The findings support the broader adoption of SILAARP in pediatric surgical centers for managing ARM and associated fistulas.
Background:
This study aims to evaluate the safety and efficacy of single-incision laparoscopic-assisted anorectoplasty (SILAARP) for children with anorectal malformations (ARM) and rectourethral or rectovesical fistula.
Methods:
Children with ARMs and rectourethral or rectovesical fistula who underwent SILAARP between May 2011 and December 2012 were reviewed. The operative time, early postoperative and follow-up results were analyzed.
Results:
Thirty-one patients (ARM with rectovesical vs. rectoprostatic fistula vs. rectobulbar fistula: 9/6/16) successfully underwent SILAARPs without conversions. Mean ages at operation were similar in 2 groups (ARM with rectovesical or rectoprostatic fistula vs. ARM with rectobulbar fistula: 4.94 months vs. 5.67 months, p=0.46). Average operative time in ARM children with rectobulbar fistula was 1.94 hours, which did not differ from 1.78 hours in ARM children with rectovestical or rectoprostatic fistula (p=0.39). All patients resumed feeding on postoperative day 1. The median follow-up period was 20 months. No injuries of vessels, urethral or vas deferens occurred in operations. No mortality or morbidities of wound infection, rectal retraction, recurrent fistula, urethral diverticulum, anal stenosis, or rectal prolapse was encountered.
Conclusions:
SILAARP is safe, feasible and effective for ARM with rectourethral or rectovesical fistula. One-stage SILAARP may offer a viable alternative treatment for ARM children with rectourethral or rectovesical fistula.
