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Postoperative "complications" following laparoscopic-assisted anorectoplasty: A systematic review
Manish Pathak1, Amulya K Saxena2
1Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Basni Industrial Area, MIA, 2nd Phase, Basni, Jodhpur, 342005, India. dr1manishpathak@gmail.com.
Aim:
This study reviewed the literature on the postoperative complications following laparoscopic-assisted anorectoplasty (LAARP).
Methods:
A Medline and Embase search was performed for the terms "anorectal malformation" (ARM) "laparoscopic" and "complication". Articles without English full text, review articles, systematic reviews, case reports, case series < 5 cases and duplicate articles were excluded. Two reviewers independently performed the eligibility assessment and data extraction. Data were collected for type of malformation, surgical technique, postoperative complications and functional outcomes RESULTS: The search retrieved 108 articles, of which 38 met the inclusion criteria and offered 1058 patients for analysis. Rectoprostatic and rectobladder neck fistula were the most common types of ARM in males, whereas it was the common cloaca in females. Analysis of complications demonstrated rectal prolapse (n = 149; 14.08%) being the most prominent, followed by urethral diverticulum (n = 32; 3.02%), anal stenosis (n = 37; 3.49%), recurrent fistula (n = 7; 0.66%) and rectal stricture (n = 4; 0.37%). Krickenbeck classification was used for functional assessment in 638 patients, with fecal soiling grade 2 or > 2 in 79. Data on functional outcome specific to the type of malformation was available for 246 patients: fecal soiling grade 2 or > 2 in 15/94 (15.95%) with rectoprostatic fistula, 26/73 (35.61%) with rectobladder neck fistula, 6/47 (12.76%) with common cloaca, and 1/22 (4.54%) with no fistula.
Conclusion:
Rectal prolapse, posterior urethral diverticulum and anal stenosis are the most common complications after LAARP. Inconsistent and non-uniform functional assessment and non-availability of information about the sacrum and spine make it difficult to analyze the functional outcome following LAARP.
Insights
Laparoscopic-assisted anorectoplasty (LAARP) is associated with rectal prolapse, urethral diverticulum, and anal stenosis as common complications. Functional outcomes are challenging to assess due to inconsistent reporting in the literature.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Anorectal malformations (ARM) are congenital conditions requiring surgical correction.
- Laparoscopic-assisted anorectoplasty (LAARP) is a minimally invasive approach for ARM treatment.
- Understanding postoperative complications is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To systematically review the literature on postoperative complications following LAARP.
- To identify the most frequent complications and assess functional outcomes after LAARP.
Main Methods:
- A comprehensive literature search was conducted on Medline and Embase using relevant keywords.
- Studies were screened for eligibility, and data on malformation type, surgical technique, complications, and functional outcomes were extracted.
- 38 articles comprising 1058 patients met the inclusion criteria.
Main Results:
- Rectal prolapse (14.08%) was the most common complication, followed by anal stenosis (3.49%) and urethral diverticulum (3.02%).
- Functional outcomes varied, with fecal soiling reported in 15.95% of rectoprostatic fistula cases and 35.61% of rectobladder neck fistula cases.
- Inconsistent functional assessment methods and missing data on spinal/sacral anomalies hindered comprehensive outcome analysis.
Conclusions:
- Rectal prolapse, urethral diverticulum, and anal stenosis are significant postoperative complications of LAARP.
- Standardized functional outcome assessment and reporting are needed for better evaluation of LAARP efficacy.
