Abstract
Background Posterior or anterior sagittal anorectoplasty (ASARP) is the mainstream for correcting
rectovestibular fistula (RVF). However, the intermediate RVF has the potential risk
of wound complications when applying ASARP due to its high rectal pouch, long fistula
tract, and difficulty separating the rectum and vagina. We developed laparoscopic-assisted
anorectoplasty (LAARP) for surgical correction of RVF, which has acceptable preliminary
outcomes. The purpose of this study is to evaluate the safety and efficacy of LAARP
in comparison with ASARP for patients with RVF.
Materials and Methods Twenty-five patients with RVF who underwent LAARP between October 2017 and December
2020 were retrospectively reviewed. The outcomes were compared with 43 patients who
underwent ASARP between April 2015 and August 2018. The age, weight at operation,
sacral ratio, operative time, and postoperative hospital stay were evaluated. The
results were assessed for complications, perineum appearance, and bowel function.
Results The two groups were comparable in terms of demographics. The median operative time
of the LAARP group was significantly longer than that of the ASARP group (113 vs.
95 minutes; p = 0.015). The mean length of the resected rectum in the LAARP group was also longer
than that in the ASARP group (6.75 ± 5.07 vs. 3.31 ± 3.06 cm; p = 0.001). Compared with the LAARP group, complications in the ASARP group were more
frequent (4.0 vs. 27.9%, p = 0.036). No intraoperative or postoperative wound-related complications occurred
in the LAARP group. However, in the ASARP group, one patient had an intraoperative
vaginal injury and four had postoperative anastomosis-related complications. The incidence
of redo operation in the ASARP group was significantly higher than that in the LAARP
group (p = 0.000). Cosmetic satisfaction was higher in the LAARP group (96.0 vs. 76.7%; p < 0.05). In terms of voluntary bowel movement, soiling, and constipation, the LAARP
group had similar results compare with the ASARP group.
Conclusion The LAARP technique has shown several unique strengths in treating intermediate type
RVF, including lower risks of complications, and minimal muscular injury, with a comparable
bowel function.
Keywords
anorectal malformation - rectovestibular fistula - laparoscopic-assisted anorectoplasty
- anterior sagittal anorectoplasty
