The Current Practice of Laparoscopically Assisted Anorectoplasty for Male Patients - An International Pediatric...

Laparoscopically assisted anorectoplasty (LAARP) is a common surgical approach for male patients with anorectal malformations requiring access to the abdominal cavity. Long-term outcomes are comparable to those of traditional approaches, such as posterior sagittal anorectoplasty. However, technical variations in practice are widespread. In this study, we investigated the factors and trends in surgeons' preferences when performing LAARP.

An anonymous online survey with 22 questions was distributed electronically to International Pediatric Endosurgery Group (IPEG) members in 2024.

The survey received complete responses from 175 IPEG members (196 of 1678 respondents, a 19.9 % rate). Respondents were from Asia (n = 49, 28.0 %), Europe (n = 42, 24 %), North America (n = 37, 21.1 %), Latin America (n = 27, 15.4 %), and other regions (n = 20, 11.0 %). Most respondents performed 1-2 LAARP procedures annually (n = 110, 62.9 %), whereas 25.7 % (n = 45) managed 3-5 cases yearly. LAARP was performed for the rectovesical (n = 165, 94.3 %), rectoprostatic (n = 143, 81.7 %), and rectobulbar urethral (n = 56, 32.0 %) fistulas. For fistula dissection, 70.2 %(n = 123) preferred monopolar instruments, whereas 21.7 % (n = 38) preferred bipolar. Fistula closure was managed solely on external appearance (58 %), transfixing sutures (53 %), and division (5 %). Nearly all surgeons use transcutaneous electrostimulation from the perineum to ensure accuracy in creating a pull-through route through the anal sphincter complex. The stoma was closed 2-3 months after LAARP (69 %).

This survey highlighted the limited annual LAARP case volume per surgeon and the significant variability in surgical practices across the pre-, intra-, and post-operative stages. Further studies are warranted to assess technique effects on patient outcomes (248 / 250).