Long-term outcomes of male imperforate anus with recto-urethral fistula: laparoscopy-assisted anorectoplasty versus posterior sagittal anorectoplasty

Koga, Hiroyuki; Miyake, Yuichiro; Yazaki, Yuta; Ochi, Takanori; Seo, Shogo; Lane, Geoffrey J.; Yamataka, Atsuyuki

doi:10.1007/s00383-022-05106-1

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…[22,23] Indeed, the previously reported incidence of post-LAARP rectal prolapse ranged from 30–59%, which was higher than that of the PSARP control group. [4,23,26] According to clinical experience from CIP, maintaining the correct tension of rectum-anal anastomosis while placing the anoplasty sutures could reduce the rate of rectal prolapse. The modified techniques to achieve this are as follows: (1) to aovid over-extensive mobilization of the rectum, we recommend dissection of the mesorectum from the peritoneal reflection without transection of the superior rectal artery; (2) the redundant rectum and surrounding tissue may be trimmed symmetrically to maintain proper tension of rectum-anal anastomosis (slight invagination of the neo-anus) and avoid the mucosal ectropion of the neo-anus.…”

Section: Discussionmentioning

confidence: 99%

“…The latest results regarding the long-term outcomes of ARM with RBF from Koga et al reported that the incidence of rectal prolapse was 32% (8/25), which was significantly greater than in the PSARP group. [22,23] Finally, the value of LAARP on bowel function has been questioned, owing to the short follow-up and subjective parameters of the scores. [22] In our study, we found no significant differences in operative time or postoperative complications between the LAARP and PSARP groups.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the incidence of rectal prolapse was comparable between 2 groups (9.3% vs 17.8%, LAARP vs PSARP), which contradicts the commonly held belief that LAARP may increase the risk of rectal prolapse. [22,23] Indeed, the previously reported incidence of post-LAARP rectal prolapse ranged from 30–59%, which was higher than that of the PSARP control group. [4,23,26] According to clinical experience from CIP, maintaining the correct tension of rectum-anal anastomosis while placing the anoplasty sutures could reduce the rate of rectal prolapse.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic-assisted anorectoplasty for anorectal malformation with rectobulbar fistula: A two-center comparative study with posterior sagittal anorectoplasty

Ye,

Feng,

Zhou

et al. 2023

Medicine

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Due to the controversy on the feasibility of laparoscopic-assisted anorectoplasty (LAARP) for the treatment of the anorectal malformation (ARM) with rectobulbar fistula (RBF), this study aimed to compare the outcomes of LAARP and posterior sagittal anorectoplasty (PSARP) for ARM with RBF. Demographic data, postoperative complications, and bowel function of RBF patients who underwent LAARP and PSARP at 2 medical centers from 2016–2018 were retrospectively reviewed. Eighty-eight children with RBF were enrolled, including 43 in the LAARP group and 45 in the PSARP group. There were no significant differences in the sacral ratio (P = .222) or sacral agenesis (P = .374). Thirty-seven and 38 patients in the LAARP and PSARP groups were followed up for a median of 4.14 years. The postoperative complications were comparable between the groups (P = .624), with no cases of urethral diverticulum. The urination of all cases was normal and no evidence of cyst formation was found on MCU or MRI during the follow-up period. The incidence of rectal prolapse was similar between the 2 groups (9.3% vs 17.8%, P = .247). The groups had equivalent Bowel Function Score (15.29 ± 2.36 vs 15.58 ± 2.88, P = .645), but the LAARP group had better voluntary bowel movement (94.6% vs 84.2%, P = .148) by Krickenbeck classification. The intermediate-term outcomes of LAARP show that the urethral diverticulum was rare by the intraluminal incision of the fistular and the bowel function was comparable to that of PSARP in ARM with rectobulbar fistula. However, LAARP was associated with smaller perineal wounds.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Laparoscopic-assisted anorectoplasty for anorectal malformation with rectobulbar fistula: A two-center comparative study with posterior sagittal anorectoplasty

Ye,

Feng,

Zhou

et al. 2023

Medicine

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“…Nevertheless, medical progress relies on innovation. Sphincter-sparing techniques such as the laparoscopic-assisted anorectoplasty proposed by Georgeson [ 3 ] have been shown to have favorable outcomes concerning long-term functional outcomes in terms of continence [ 4 ]. The PARP was devised as a sphincter-sparing technique for the repair of lower anorectal malformations in boys and in those without fistulae in both sexes.…”

mentioning

confidence: 99%

Reply to Peña, A. Comment on “Küppers et al. Percutaneous Anorectoplasty (PARP)—An Adaptable, Minimal-Invasive Technique for Anorectal Malformation Repair. Children 2022, 9, 587”

et al. 2022

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How many cases do instructor class pediatric surgeons need to experience to be an independent operator in performing advanced endoscopic surgery? A nationwide survey to establish an ideal curriculum for pediatric endoscopic surgery in Japan

Murakami,

Onishi,

Yamada

et al. 2023

Pediatr Surg Int

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Purpose: To ensure the safe spread of pediatric endoscopic surgery, it is essential to build a training curriculum, and a survey of the current situation in Japan is necessary. The present study assessed an e cient training curriculum by clarifying instructor class pediatric surgeons' experiences, including autonomy when performing advanced endoscopic surgeries.Methods: An online nationwide questionnaire survey was conducted among pediatric surgeons who had Endoscopic Surgical Skill Quali cation (ESSQ) and board-certi ed instructors who had skills comparable to ESSQ. We assessed participants' training experience, opinions concerning the ideal training curriculum and the correlation between surgical experience and the level of autonomy. The Zwisch scale was used to assess autonomy.Results: Fifty-two participants responded to the survey (response rate: 86.7%). Only 57.7% of the respondents felt that they had received su cient endoscopic surgery training. Most respondents considered an educational curriculum for endoscopic surgery including off-the-job training essential during the training period. Autonomy had been acquired after experiencing two to three cases for most advanced endoscopic surgeries.Conclusion: This rst nationwide survey in Japan showed that instructor class pediatric surgeons acquired autonomy after experiencing two to three for most advanced endoscopic surgeries. Our ndings suggest that training, especially off-the-job training, has been insu cient.

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Long-term outcomes of male imperforate anus with recto-urethral fistula: laparoscopy-assisted anorectoplasty versus posterior sagittal anorectoplasty

Cited by 6 publications

References 18 publications

Laparoscopic-assisted anorectoplasty for anorectal malformation with rectobulbar fistula: A two-center comparative study with posterior sagittal anorectoplasty

Laparoscopic-assisted anorectoplasty for anorectal malformation with rectobulbar fistula: A two-center comparative study with posterior sagittal anorectoplasty

Reply to Peña, A. Comment on “Küppers et al. Percutaneous Anorectoplasty (PARP)—An Adaptable, Minimal-Invasive Technique for Anorectal Malformation Repair. Children 2022, 9, 587”

How many cases do instructor class pediatric surgeons need to experience to be an independent operator in performing advanced endoscopic surgery? A nationwide survey to establish an ideal curriculum for pediatric endoscopic surgery in Japan

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