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

Abstract

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.

Laparoscopic-Assisted Modified Posterior Sagittal Anorectoplasty for Rectobulbar Urethral Fistula of Anorectal Malformation

“…[ 1 5 6 7 ] However, there is an ongoing debate regarding the role of LAARP in the RBUF. [ 8 ] In RBUF, the rectum shares a long common wall with the urethra, leading to difficulty in dissecting the fistula along the urethra in an infant's narrow pelvis. [ 2 3 4 8 ] Overzealous dissection may lead to urethral injuries; on the other hand, an overcautious approach leads to retaining a long segment of residual fistula leading to UD in up to 18% of cases.…”

“…[ 8 ] In RBUF, the rectum shares a long common wall with the urethra, leading to difficulty in dissecting the fistula along the urethra in an infant's narrow pelvis. [ 2 3 4 8 ] Overzealous dissection may lead to urethral injuries; on the other hand, an overcautious approach leads to retaining a long segment of residual fistula leading to UD in up to 18% of cases. [ 4 9 10 11 ] On the contrary, Pena's posterior sagittal anorectoplasty (PSARP) allows complete and safe dissection of the RBUF but is associated with difficult mobilization of extrapelvic rectum/colon and bisection of perineal musculature/puborectalis as its major disadvantages against LAARP.…”

Perbandingan Posterior Sagittal Anorectoplasty (PSARP) dengan Laparoscopy Assisted Anorectoplasty (LAARP) dalam Tatalaksana Malformasi Anorektal

“…Ayu Santia Dewi 1 *, Ni Made Puspasari Mahadewi 1 , Dimas Zul Fariqhan 1 , I Made Brama Atmaja 1 , Arif Zuhan 2 PENDAHULUAN Anorectal Malformations (ARMs) merupakan suatu kelainan kongenital langka yang dominan pada laki-laki dengan angka kejadian 1:5000 kejadian pada bayi baru lahir [1][2][3]. Pasien ini lahir dengan lubang anus yang tidak normal akibat perkembangan abnormal pada traktus urinarius, reproduksi dan gastrointestinal [1,3].…”

“…PSARP adalah metode operatif yang dikenalkan oleh de Vries dan Pena. Tindakan operasi ini paling banyak digunakan oleh praktisi, dikarenakan teknik yang dinamis dan hasil operasi yang baik dalam fungsi usus dan kontinensia feses [2]. PSARP merupakan operasi pembuatan anus dengan cara membelah muskulus sfingter eksternus dan muskulus levator ani untuk memudahkan mobilisasi dari kantong rektum dan pemotongan fistula [2].…”

“…Tindakan operasi ini paling banyak digunakan oleh praktisi, dikarenakan teknik yang dinamis dan hasil operasi yang baik dalam fungsi usus dan kontinensia feses [2]. PSARP merupakan operasi pembuatan anus dengan cara membelah muskulus sfingter eksternus dan muskulus levator ani untuk memudahkan mobilisasi dari kantong rektum dan pemotongan fistula [2]. Tindakan definitif PSARP sebaiknya dilakukan ketika usia 8-12 minggu (3 bulan) setelah dilakukannya tindakan kolostomi, karena selama periode penundaan tersebut dapat dilakukan evaluasi kelainan penyerta lain yang dapat mempengaruhi tindakan definitif ini.…”