Anorectal Anomalies in Adults-Laparoscopic Management and Review of Literature

Abstract

Anorectal malformations (ARMs) are one of the most common congenital anomalies dealt by surgeons. The reported incidence of ARMs range between 1:3,300 and 1:5,000 live births. These defects are invariably detected and treated in infancy or early childhood. There is a group of patients among these who have fistulous external opening from the rectum. These may not present in child hood and may continue to live with fecal incontinence till adult hood. One of such anomalies is rectovaginal fistulas which comprises of only 4% of all anomalies. Delayed management in such cases increases surgical and functional complications. Traditionally high and intermediate anorectal anomalies are treated by posterior sagittal anorectoplasty (PSARP). This involves cutting of sphincter muscles in the midline and then placement of rectum in the sphincter complex. The continence results of this operation are less than ideal. Laparoscopically assisted anorectal pull-through (LAARP) has potential advantage of precise placement of the rectum inside the sphincter complex without dividing and weakening the muscles, diminished soft tissue scarring around the rectum leading to improved rectal compliance. Three adult female patients with ARMs were managed through LAARP procedure. It involves dissection around rectum, identification and ligation of fistula tract, creation of neoanus and pull through of rectum into neoanus. Results-Continence was good in all our patients which they regained after 3 to 4 days of surgery. On follow up which ranged from 6 months to 2 years all were passing well formed stools 1-2 times a day and have symmetric anal contraction with strong squeeze on digital rectal examination. Conclusion-LAARP offers an excellent option to the patients of ARM over conventional posterior sagittal anorectal approach because if its theoretical advantages of early recovery and better continence. Long term followup is needed to substantiate these results.

Late Diagnosis of Anorectal Malformations in Children

“…Expressions like "delayed presentation" or "late diagnosis" of ARM are used by different authors for patients who presented beyond 24 hours of birth [10] [11], 48 hours of birth [5] [12], 7 days of birth and beyond 6 months of age for female patients with low-type ARM [8]. Some of them continue to live with ARM suffering of constipation or sometimes with fecal incontinence till adulthood [13] without recognizing the real cause of their complaints. Delay in establishing of diagnosis consequently delays proper treatment and increases the rate of morbidity and mortality [7].…”

Unusual Presentation of a Rectovestibular Fistula as Gastrointestinal Hemorrhage in a Postmenopausal Woman

“…Interestingly enough, our patient had no other anomalies or evidence of genetic dysmorphology. It is believed that the vast majority of cases are identified at birth and corrected surgically [ 3 ]. The patient's own granddaughter had an imperforate anus identified at birth, which was repaired.…”

Technical Considerations in Primary Repair of a Congenital Prostatic Rectourethral Fistula in an Adult-Sized Patient

“…Diagnosis is sometimes missed in children with occult perineal or rectovestibular fistulae, delaying repair into adolescence and adulthood. [1][2][3][4][5] Once diagnosed, the malformation is often corrected with a standard posterior sagittal anorectoplasty (although laparoscopic assistance has been described, 5 especially for proximal fistulas).…”