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Eur J Pediatr Surg 2020; 30(02): 156-163
DOI: 10.1055/s-0040-1701700
Review Article
Georg Thieme Verlag KG Stuttgart · New York

The Role of Laparoscopy in Anorectal Malformations

Rebecca M. Rentea 
1   Comprehensive Colorectal Center, Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Devin R. Halleran
2   Center for Colorectal and Pelvic Reconstruction, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Richard J. Wood
2   Center for Colorectal and Pelvic Reconstruction, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Marc A. Levitt
3   Department of Pediatric Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
› Author Affiliations
Further Information

Publication History

22 October 2019

07 January 2020

Publication Date:
04 March 2020 (online)

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Abstract

The use of laparoscopy in the minimally invasive management of anorectal malformations (ARMs) continues to evolve, although the principles guiding the anatomic surgical repair and clinical follow-up remain unchanged. In this review, we detail the advantages, indications, contraindications, complications, and issues unique to the minimally invasive approach to ARM. A comprehensive search of the PubMed and Embase databases was performed (2014–2018). Full-text screening, data abstraction, and quality appraisal were performed of articles describing the use of laparoscopy in ARM and cloaca. While new developments and approaches to ARM utilizing minimally invasive techniques and timing for surgical approach have been detailed, a unique complication profile involving greater risk of rectal prolapse and retention of a remnant of the original fistula are still consistently reported. Analysis of perioperative complications and long-term functional outcomes, including rates of fecal and urinary continence, are lacking. It is clear that patient selection for the choice of surgical approach based on precise preoperative delineation of the anatomy is the key. Adherence to the principles of ARM repair as well as application of operative/imaging adjuncts will yield the best technically safe minimally invasive approach to ARM. Continued efforts for standardized reporting and long-term follow-up are required.

Keywords

anorectal malformation - minimally invasive - posterior sagittal anorectoplasty - laparoscopic-assisted anorectal pull-through - laparoscopy - cloaca
 

  • References

  • 1 Georgeson KE, Inge TH, Albanese CT. Laparoscopically assisted anorectal pull-through for high imperforate anus--a new technique. J Pediatr Surg 2000; 35 (06) 927-930
    CrossrefPubMedGoogle Scholar
  • 2 Wood RJ, Reck-Burneo CA, Dajusta D. , et al. Cloaca reconstruction: a new algorithm which considers the role of urethral length in determining surgical planning. J Pediatr Surg 2017; pii: S0022-3468(17)30644-9
    PubMedGoogle Scholar
  • 3 Chung PHY, Wong KKY, Tam PKH. Management of anorectal malformations in the era of laparoscopy. Surg Pract 2014; 18: 94-97
    CrossrefPubMedGoogle Scholar
  • 4 Holbrook C, Misra D, Zaparackaite I, Cleeve S. Post-operative strictures in anorectal malformation: trends over 15 years. Pediatr Surg Int 2017; 33 (08) 869-873
    CrossrefPubMedGoogle Scholar
  • 5 Koga H, Ochi T, Okawada M, Doi T, Lane GJ, Yamataka A. Comparison of outcomes between laparoscopy-assisted and posterior sagittal anorectoplasties for male imperforate anus with recto-bulbar fistula. J Pediatr Surg 2014; 49 (12) 1815-1817
    CrossrefPubMedGoogle Scholar
  • 6 Pandey V, Gangopadhyay AN, Gupta DK, Sharma SP, Kumar V. Management of anorectal malformation without ligation of fistula: an approach preventing posterior urethral diverticula. J Pediatr Urol 2014; 10 (06) 1149-1152
    CrossrefPubMedGoogle Scholar
  • 7 Samuk I, Bischoff A, Hall J, Levitt M, Peña A. Anorectal malformation with rectobladder neck fistula: a distinct and challenging malformation. J Pediatr Surg 2016; 51 (10) 1592-1596
    CrossrefPubMedGoogle Scholar
  • 8 Tainaka T, Uchida H, Tanaka Y. , et al. Long-term outcomes and complications after laparoscopic-assisted anorectoplasty vs. posterior sagittal anorectoplasty for high- and intermediate-type anorectal malformation. Pediatr Surg Int 2018; 34 (10) 1111-1115
    CrossrefPubMedGoogle Scholar
  • 9 Yazaki Y, Koga H, Ochi T. , et al. Surgical management of recto-prostatic and recto-bulbar anorectal malformations. Pediatr Surg Int 2016; 32 (10) 939-944
    CrossrefPubMedGoogle Scholar
  • 10 Ming AX, Li L, Diao M. , et al. Long term outcomes of laparoscopic assisted anorectoplasty: a comparison study with posterior sagittal anorectoplasty. J Pediatr Surg 2014; 49 (04) 560-563
    CrossrefPubMedGoogle Scholar
  • 11 Yang L, Tang ST, Li S. , et al. Two-stage laparoscopic approaches for high anorectal malformation: transumbilical colostomy and anorectoplasty. J Pediatr Surg 2014; 49 (11) 1631-1634
    CrossrefPubMedGoogle Scholar
  • 12 Ren X, Xiao H, Li L. , et al. Single-incision laparoscopic-assisted anorectoplasty versus three-port laparoscopy in treatment of persistent cloaca: a midterm follow-up. J Laparoendosc Adv Surg Tech A 2018; 28 (12) 1540-1547
    CrossrefPubMedGoogle Scholar
  • 13 Wang C, Li L, Cheng W. , et al. A new approach for persistent cloaca: Laparoscopically assisted anorectoplasty and modified repair of urogenital sinus. J Pediatr Surg 2015; 50 (07) 1236-1240
    CrossrefPubMedGoogle Scholar
  • 14 Wang C, Li L, Diao M. , et al. Single-incision laparoscopic-assisted anorectoplasty for the management of persistent cloaca. J Laparoendosc Adv Surg Tech A 2016; 26 (04) 328-333
    CrossrefPubMedGoogle Scholar
  • 15 Minaev SV, Kirgizov IV, Gladkyy A, Shishkin I, Gerasimenko I. Outcome of laparoscopic treatment of anorectal malformations in children. World J Surg 2017; 41 (02) 625-629
    CrossrefPubMedGoogle Scholar
  • 16 Bischoff A, Bealer J, Peña A. Controversies in anorectal malformations. Lancet Child Adolesc Health 2017; 1 (04) 323-330
    PubMedGoogle Scholar
  • 17 Bischoff A, Bealer J, Wilcox DT, Peña A. Error traps and culture of safety in anorectal malformations. Semin Pediatr Surg 2019; 28 (03) 131-134
    CrossrefPubMedGoogle Scholar
  • 18 Bischoff A, Martinez-Leo B, Peña A. Laparoscopic approach in the management of anorectal malformations. Pediatr Surg Int 2015; 31 (05) 431-437
    CrossrefPubMedGoogle Scholar
  • 19 Cairo SB, Rothstein DH, Harmon CM. Minimally invasive surgery in the management of anorectal malformations. Clin Perinatol 2017; 44 (04) 819-834
    CrossrefPubMedGoogle Scholar
  • 20 Han Y, Xia Z, Guo S, Yu X, Li Z. Laparoscopically assisted anorectal pull-through versus posterior sagittal anorectoplasty for high and intermediate anorectal malformations: a systematic review and meta-analysis. PLoS One 2017; 12 (01) e0170421
    CrossrefPubMedGoogle Scholar
  • 21 Shawyer AC, Livingston MH, Cook DJ, Braga LH. Laparoscopic versus open repair of recto-bladderneck and recto-prostatic anorectal malformations: a systematic review and meta-analysis. Pediatr Surg Int 2015; 31 (01) 17-30
    CrossrefPubMedGoogle Scholar
  • 22 Chung PHY, Wong CWY, Wong KKY, Tam PKH. Assessing the long term manometric outcomes in patients with previous laparoscopic anorectoplasty (LARP) and posterior sagittal anorectoplasty (PSARP). J Pediatr Surg 2018; 53 (10) 1933-1936
    CrossrefPubMedGoogle Scholar
  • 23 Brisighelli G, Di Cesare A, Morandi A. , et al. Classification and management of rectal prolapse after anorectoplasty for anorectal malformations. Pediatr Surg Int 2014; 30 (08) 783-789
    CrossrefPubMedGoogle Scholar
  • 24 Diao M, Li L, Ye M, Cheng W. Single-incision laparoscopic-assisted anorectoplasty using conventional instruments for children with anorectal malformations and rectourethral or rectovesical fistula. J Pediatr Surg 2014; 49 (11) 1689-1694
    CrossrefPubMedGoogle Scholar
  • 25 Leung JL, Chung PH, Tam PK, Wong KK. Application of anchoring stitch prevents rectal prolapse in laparoscopic assisted anorectal pullthrough. J Pediatr Surg 2016; 51 (12) 2113-2116
    CrossrefPubMedGoogle Scholar
  • 26 Lopez M, Kalfa N, Allal H. , et al. Anorectal malformation (ARM) with bladder fistula: advantages of a laparoscopic approach. Eur J Pediatr Surg 2014; 24: e3-e4
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Ramasundaram M, Sundaram J, Agarwal P, Bagdi RK, Bharathi S, Arora A. Institutional experience with laparoscopic-assisted anorectal pull-through in a series of 17 cases: a retrospective analysis. J Minim Access Surg 2017; 13 (04) 265-268
    CrossrefPubMedGoogle Scholar
  • 28 Ruggeri G, Destro F, Randi B, Lima M. Laparoscopic-assisted anorectal pull-through for high imperforate anus: 14 years experience in a single center. J Laparoendosc Adv Surg Tech A 2016; 26 (05) 404-408
    CrossrefPubMedGoogle Scholar
  • 29 Slater BJ, Kay S, Rothenberg SS. Use of the 5-mm endoscopic stapler for ligation of fistula in laparoscopic-assisted repair of anorectal malformation. J Laparoendosc Adv Surg Tech A 2018; 28 (06) 780-783
    CrossrefPubMedGoogle Scholar
  • 30 Thomas TT, Teitelbaum DH, Smith EA, Dillman JR, Vellody R, Jarboe MD. Magnetic resonance imaging (MRI)-assisted laparoscopic anorectoplasty for imperforate anus: a single center experience. Pediatr Surg Int 2017; 33 (01) 15-21
    CrossrefPubMedGoogle Scholar
  • 31 Ishimaru T, Kawashima H, Tainaka T. , et al. Laparoscopically assisted anorectoplasty for intermediate type of imperforate anus: comparison of surgical outcomes with the sacroperineal approach. J Laparoendosc Adv Surg Tech A 2018; 28: A18
    PubMedGoogle Scholar
  • 32 Xiao H, Chen L, Ren XH, Huang R, Diao M, Li L. One-stage laparoscopic-assisted anorectoplasty for neonates with anorectal malformation and recto-prostatic or recto-bulbar fistula according to the Krickenbeck classification. J Laparoendosc Adv Surg Tech A 2018; 28 (08) 1029-1034
    CrossrefPubMedGoogle Scholar
  • 33 Xiao H, Huang R, Chen L. , et al. The midterm outcomes of 1-stage versus 3-stage laparoscopic-assisted anorectoplasty in anorectal malformations with rectoprostatic fistula and rectobulbar fistula: a retrospective cohort study. Medicine (Baltimore) 2018; 97 (32) e11843
    PubMedGoogle Scholar
  • 34 Diao M, Li L, Guan KP, Zhang Z, Cheng W. A novel laparoscopic technique for anorectal malformation with low recto-bulbar fistulae. Surg Endosc 2017; 31 (10) 4326-4330
    CrossrefPubMedGoogle Scholar
  • 35 Diao M, Li L, Ye M, Guan KP, Wei YD, Cheng W. Congenital anomaly rectified at birth: one-stage single-incision laparoscopic-assisted anorectoplasty for newborns with anorectal malformations and recto-urethral fistula. Surg Endosc 2016; 30 (11) 5156-5164
    CrossrefPubMedGoogle Scholar
  • 36 Blinman T, Ponsky T. Pediatric minimally invasive surgery: laparoscopy and thoracoscopy in infants and children. Pediatrics 2012; 130 (03) 539-549
    CrossrefPubMedGoogle Scholar
  • 37 Reck-Burneo CA, Skerrit C, Dingemans A. , et al. Primary or redo posterior sagittal anorectoplasty without a stoma: to feed or not to feed?. European Journal of Pediatric Surgery 2019; 29: 150-152
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Gine C, Santiago S, Lara A. , et al. Two-port laparoscopic descending colostomy with separated stomas for anorectal malformations in newborns. European Journal of Pediatric Surgery 2016; 26: 462-464
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Kraus SJ, Levitt MA, Peña A. Augmented-pressure distal colostogram: the most important diagnostic tool for planning definitive surgical repair of anorectal malformations in boys. Pediatr Radiol 2018; 48 (02) 258-269
    CrossrefPubMedGoogle Scholar
  • 40 Chow JS, Paltiel HJ, Padua HM. , et al. Contrast-enhanced colosonography for the evaluation of children with an imperforate anus. Journal of Ultrasound in Medicine 2019; 38: 2777-2783
    CrossrefPubMedGoogle Scholar
  • 41 Thomeer MG, Devos A, Lequin M. , et al. High resolution MRI for preoperative work-up of neonates with an anorectal malformation: a direct comparison with distal pressure colostography/fistulography. Eur Radiol 2015; 25 (12) 3472-3479
    CrossrefPubMedGoogle Scholar
  • 42 Zhan Y, Wang J, Guo WL. Comparative effectiveness of imaging modalities for preoperative assessment of anorectal malformation in the pediatric population. J Pediatr Surg 2019; 54 (12) 2550-2553
    CrossrefPubMedGoogle Scholar
  • 43 Halleran DR, Ahmad H, Bates DG, Vilanova-Sanchez A, Wood RJ, Levitt MA. A call to ARMs: accurate identification of the anatomy of the rectourethral fistula in anorectal malformations. J Pediatr Surg 2019; 54 (08) 1708-1710
    CrossrefPubMedGoogle Scholar
  • 44 Wood RJ, Reck-Burneo CA, Levitt MA. Cloacal malformations: technical aspects of the reconstruction and factors which predict surgical complexity. Front Pediatr 2019; 7: 240
    CrossrefPubMedGoogle Scholar
  • 45 Halleran DR, Thompson B, Fuchs M. , et al. Urethral length in female infants and its relevance in the repair of cloaca. J Pediatr Surg 2019; 54 (02) 303-306
    CrossrefPubMedGoogle Scholar
  • 46 Rollins MD, Downey EC, Meyers RL, Scaife ER. Division of the fistula in laparoscopic-assisted repair of anorectal malformations-are clips or ties necessary?. J Pediatr Surg 2009; 44 (01) 298-301
    CrossrefPubMedGoogle Scholar
  • 47 Wang C, Diao M, Li L. , et al. Laparoscopic dissection and division of distal fistula in boys with rectourethral fistula. J Surg Res 2017; 211: 147-153
    CrossrefPubMedGoogle Scholar
  • 48 Morandi A, Ure B, Leva E, Lacher M. Survey on the management of anorectal malformations (ARM) in European pediatric surgical centers of excellence. Pediatr Surg Int 2015; 31 (06) 543-550
    CrossrefPubMedGoogle Scholar
  • 49 Rentea RM, Halleran DR, Vilanova-Sanchez A. , et al. Diagnosis and management of a remnant of the original fistula (ROOF) in males following surgery for anorectal malformations. J Pediatr Surg 2019; 54 (10) 1988-1992
    CrossrefPubMedGoogle Scholar
  • 50 Wood RJ, Halleran DR, Ahmad H. , et al. Assessing the benefit of reoperations in patients who suffer from fecal incontinence after repair of their anorectal malformation. J Pediatr Surg 2019 ; in press
    PubMedGoogle Scholar
  • 51 Belizon A, Levitt M, Shoshany G, Rodriguez G, Peña A. Rectal prolapse following posterior sagittal anorectoplasty for anorectal malformations. J Pediatr Surg 2005; 40 (01) 192-196
    CrossrefPubMedGoogle Scholar
  • 52 Ming AX, Li L, Diao M. , et al. Long term outcomes of laparoscopic-assisted anorectoplasty: a comparison study with posterior sagittal anorectoplasty. J Pediatr Surg 2014; 49 (04) 560-563
    CrossrefPubMedGoogle Scholar