Laparoscopic-assisted Anorectoplasty: A Single-center Experience.

Area of Science:

• Pediatric Surgery
• Surgical Techniques
• Anorectal Malformations

Background:

• High anorectal malformations (ARMs) present complex surgical challenges.
• Traditional surgical approaches may have limitations in achieving optimal outcomes.

Purpose of the Study:

• To evaluate modifications in the laparoscopic-assisted anorectal pull-through (LAARP) technique.
• To analyze the postoperative outcomes and complications associated with the refined LAARP procedure for high ARMs.

Main Methods:

• A retrospective analysis of 68 patients who underwent LAARP for high ARMs between January 2001 and May 2016.
• Technical modifications included fistula traction, division without ligation, and Hegar dilator railroading for simpler dissection and pull-through.
• Postoperative follow-up involved clinical evaluation and continence scoring.

Main Results:

• The modified LAARP procedure was successfully performed in all patients, with one conversion for adequate rectal length.
• Common complications included mucosal prolapse (8), anal stenosis (5), distal rectal necrosis (3), adhesive obstruction (2), and urethral diverticulum (2).
• Satisfactory progress, adequate weight gain, and good continence (71.15%) were observed postoperatively.

Conclusions:

• The modified LAARP procedure is a safe and effective surgical option for high ARMs.
• The technique offers good functional outcomes, with manageable and correctable side effects.
• LAARP has become the preferred method for high anorectal anomalies in the study's practice, replacing posterior sagittal anorectoplasty.