Laparoscopic surgical technique to enhance the management of anorectal malformations: 330 cases’ experience in a single center

Li, Long; Ren, Xiaobin; Ming, An-xiao; Xu, Hang; Sun, Rui; Zhou, Yan; Liu, Xuelai; Sun, Hailin; Li, Qi; Xu, Lijun; Zhang, Zhen; Wei, Cheng; Diao, Mei; Tam, Paul Kwong‐Hang

doi:10.1007/s00383-019-04614-x

Cited by 20 publications

(21 citation statements)

References 39 publications

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“… 3,12‐23 Even though 2D LAARP is considered as the preferred procedure for correction of high ARM, 3D LAARP has not been studied so far. Major steps in LAARP include finer dissection in the depth of pelvis like rectal dissection, fistula closure, and placement of rectum in the sphincter; stereopsis and depth perception provided by 3D can be highly beneficial in this situation 24 . This prompted us to conduct this study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 3D vs 2D laparoscopic‐assisted anorectal pull‐through (LAARP) for high anorectal malformations in children

Agrawal

Tiwari

Sharma

et al. 2020

Asian J Endoscop Surgery

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Introduction The limitation of two‐dimensional (2D) laparoscopic techniques includes lack of stereoscopic vision and depth perception which can affect surgical performance, physical and mental comfort of the operating surgeon. 3D laparoscopic surgery is popular in adults; however, its application and experience in the pediatric age group have been limited. We did a comparison of 2D and 3D laparoscopic‐assisted anorectal pull‐through (LAARP) in male high anorectal malformations (ARM). Material and Method This prospective cohort study included male children diagnosed with high anorectal malformation (recto‐prostatic urethral fistula) who underwent LAARP in infancy after a neonatal colostomy between November 2019 to March 2020. The patients were randomized into a 2D group or 3D group at a 1:1 ratio. Patient demographics and operative/postoperative parameters were recorded. The effect of 3D laparoscopy was assessed in terms of laparoscopy visual parameters (image quality, depth perception, hand‐eye coordination, and precision), physical discomfort (5‐point Likert scale), and mental strain (State‐Trait Anxiety Inventory scale). The statistical tests were performed on SPSS version 16. Results The demographics of both groups, 20 (patients in each), were similar. There was a significant reduction of laparoscopy execution time, physical discomfort (for eye, hand and wrist strain), and overall mental strain in the 3D group. There were similar complications, blood loss, and hospital stay, and no open conversion in two groups. Conclusion 3D LAARP is feasible and safe in the surgical treatment of ARM in children. Further studies with assessment by more than one observer are needed to investigate the wider application of 3D in pediatric surgery.

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Section: Discussionmentioning

confidence: 99%

Comparison of 3D vs 2D laparoscopic‐assisted anorectal pull‐through (LAARP) for high anorectal malformations in children

Agrawal

Tiwari

Sharma

et al. 2020

Asian J Endoscop Surgery

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“…The latter included eight studies 20,41,42,44‐48 and reported that the incidence of prolapse was 17.7% (29/164 cases) and 12.8% (18/141 cases) in the LAARP and PSARP groups, respectively, showing no significant difference between the two groups. A recent large‐scale, non‐comparative study published from a single institution in China reported that 25/330 (7.6%) LAARP patients showed prolapse and required surgical repair 49 . On the other hand, several studies reported a higher incidence of prolapse in patients after LAARP (9.4%‐50%) than after PSARP (0%‐29%), 17,20,45,46,50,51 but most of them found no significant difference (Table 2).…”

Section: Surgical Outcomesmentioning

confidence: 96%

“…Tainaka et al also reported that although there was no significant difference, PUD was identified more frequently in patients after LAARP than after PSARP, and the introduction of intraoperative urethroscopy was useful for decreasing the incidence from 40% to 11% 50 . In contrast, a large series from China reported that PUD was found in only 3/294 patients, 49 and the incidence of 1% was comparable to that of PSARP.…”

Section: Surgical Outcomesmentioning

confidence: 97%

“…Some authors pointed out another possibility; namely, that the longer dissection of the rectum in LAARP compared to PSARP could result in a higher incidence of rectal prolapse, and that a minimal dissection might be helpful in preventing morbidity 20,55 . Complete resection of the redundant rectum prior to recto‐anal anastomosis could reduce the risk of postoperative prolapse after LAARP, where this technique achieves a low incidence of 7.6% 49 …”

Section: Surgical Outcomesmentioning

confidence: 99%

“…Grade 2 and 3 soiling were recorded in 10.1% and 5.3% of patients, respectively. Furthermore, 13.6% and 11.3% of patients showed grades 1 and 2 constipation, respectively, but no patient had grade 3 constipation 49 . Tainaka et al evaluated fecal continence in patients who underwent LAARP (N = 29) or PSARP (N = 16) at the ages of 4, 8, and 12 years using the clinical assessment score for fecal continence developed by the Japanese Study Group of Anorectal Anomalies 75 .…”

Section: Surgical Outcomesmentioning

confidence: 99%

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Laparoscopically assisted anorectoplasty—Surgical procedures and outcomes: A literature review

Ishimaru

Kawashima

Hayashi

et al. 2020

Asian J Endoscop Surgery

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Anorectal malformation includes various types of anomalies. The goal of definitive surgery is achievement of fecal continence. Twenty years have passed since laparoscopically assisted anorectoplasty (LAARP) was reported by Georgeson. Since LAARP is gaining popularity, its long‐term outcomes should be evaluated. Presently, there is no evidence regarding the optimal method of ligating and dividing the fistula correctly and creating the pull‐through canal accurately. Rectal prolapse and remnant of the original fistula (ROOF) tend to develop more often in LAARP patients than in posterior sagittal anorectoplasty (PSARP) patients; however, robust evidence is not available. Prolapse may be prevented by suture fixation of the rectum to the presacral fascia; however, if prolapse occurs, the indication, timing, and the best method for surgical correction remain unclear. Most patients with ROOF are asymptomatic, and there is controversy regarding the indications for ROOF resection. This article aimed to detail the various modifications of the LAARP procedures reported previously and to describe the surgical outcomes, particularly focusing on rectal prolapse, ROOF, and fecal continence, by reviewing the literature. Functional outcomes after LAARP were almost similar to those noted after PSARP, and we have demonstrated that LAARP is not inferior to PSARP with respect to fecal continence. Although there is controversy regarding the application of LAARP for recto‐bulbar cases, we believe that LAARP is still evolving, and we can achieve better outcomes by improving the procedure.

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Reply to the letter to the editor concerning: “Normal anorectal musculatures and changes in anorectal malformation.”

Diao

Ren

et al. 2020

Pediatr Surg Int

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Laparoscopic surgical technique to enhance the management of anorectal malformations: 330 cases’ experience in a single center

Cited by 20 publications

References 39 publications

Comparison of 3D vs 2D laparoscopic‐assisted anorectal pull‐through (LAARP) for high anorectal malformations in children

Comparison of 3D vs 2D laparoscopic‐assisted anorectal pull‐through (LAARP) for high anorectal malformations in children

Laparoscopically assisted anorectoplasty—Surgical procedures and outcomes: A literature review

Reply to the letter to the editor concerning: “Normal anorectal musculatures and changes in anorectal malformation.”

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