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Outcome of Laparoscopic Treatment of Anorectal Malformations in Children
Sergey V Minaev1, Igor V Kirgizov2, Aleksander Gladkyy3
1Department of Pediatric Surgery, Stavropol State Medical University, Stavropol, Russian Federation. sminaev@yandex.ru.
Insights
Laparoscopic-assisted anorectal pull-through surgery effectively corrects anorectal malformations (ARMs) in children, achieving good functional outcomes and minimizing complications. This minimally invasive approach demonstrates promising results for pediatric surgical correction of ARMs.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Anorectal malformations (ARMs) present significant challenges in pediatric surgical correction.
- Laparoscopic techniques offer a potential solution for improved outcomes in ARM treatment.
Purpose of the Study:
- To evaluate the outcomes of laparoscopic-assisted anorectal pull-through procedures in children with ARMs.
- To assess the efficacy and safety of this minimally invasive approach.
Main Methods:
- A retrospective analysis of 104 laparoscopic-assisted anorectal pull-through procedures performed between 2007 and 2014.
- Data collected included surgical duration, intraoperative bleeding, complications, and postoperative functional outcomes.
Main Results:
- The mean operative time was 126.5 minutes with minimal bleeding (20g).
- Conversion to laparotomy occurred in 2.9% of cases, and a pelvic abscess in 0.9%.
- Good functional results were achieved in 54.2% of patients, with 93.1% showing good outcomes on barium enema.
Conclusions:
- Laparoscopic-assisted anorectal pull-through is an effective method for correcting ARMs, preserving rectal and anal structures.
- The technique, potentially enhanced by double bipolar myostimulation, leads to favorable surgical and functional results in pediatric patients.
Background:
Operative correction of anorectal malformations (ARMs) remains a challenge in pediatric surgery. The study aimed to evaluate the outcomes of laparoscopic treatment of ARM in children.
Methods:
From 2007 to 2014, we performed 104 laparoscopic-assisted anorectal pull-through procedures in children with a mean age of 11.3 ± 0.4 months and ARMs. Clinical assessment, surgical durations, complications, and postoperative outcome were investigated.
Results:
The mean duration of the operation was 126.5 ± 17.2 min. Mean intraoperative bleeding was 20 ± 5.7 g. Three (2.9 %) children required conversion to laparotomy. One (0.9 %) child developed a pelvic abscess, requiring an additional intervention. Three to six months after laparoscopic-assisted anorectal pull-through, 72 patients were hospitalized for stoma closure. Good functional results were achieved in 39 (54.2 %) patients. On examination of the perineum, 11 (15.3 %) patients were found to have mucosal prolapse. The circular symmetric anal reflex to tactile stimulation was confirmed in 53 (73.6 %) patients and a tactile weakened anal reflex in 5 (6.9 %) children. At the 1-year follow-up, constipation was present in nine (12.5 %) patients and soling in two (2.8 %) patients. A barium enema study performed after the operation showed good outcomes in 67 (93.1 %) patients and fair outcomes in 5 (6.9 %) patients. None had a poor outcome.
Conclusions:
Our experience confirms that laparoscopic-assisted anorectal pull-through enabled complete correction of ARM in the meanwhile avoiding damage to the rectum and anus. Also, the technique of double bipolar myostimulation of muscle complex in laparoscopic ARM might lead to these better results.
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