Eur J Pediatr Surg 2022; 32(05): 408-414
DOI: 10.1055/s-0041-1740157
Original Article

Laparoscopic-Assisted Anorectoplasty for Rectovestibular Fistula: A Comparison Study with Anterior Sagittal Anorectoplasty

Yan Zhou
1   Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, People's Republic of China
2   Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
,
Hang Xu
1   Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, People's Republic of China
,
Anxiao Ming
1   Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, People's Republic of China
,
Mei Diao
1   Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, People's Republic of China
,
Hailin Sun
3   Department of Medical Imaging, Capital Institute of Pediatrics, Beijing, People's Republic of China
,
Xianghui Xie
1   Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, People's Republic of China
,
Long Li
1   Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, People's Republic of China
› Institutsangaben
Funding This work was supported by the Pediatric Medical Coordinated Development Center of Beijing Hospitals Authority, No. XTZD20180302 and Fundamental Research Funds for the Central University, No. 3332019166.

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.

Research Involving Human Participants

Ethical approval was obtained from the Ethics Committee of the Capital Institute of Pediatrics (No.: SHERLL 2015024).


Informed Consent

Written informed consents were obtained from the parents before surgery.




Publikationsverlauf

Eingereicht: 16. Juni 2021

Angenommen: 01. Oktober 2021

Artikel online veröffentlicht:
01. Dezember 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Levitt MA, Peña A. Anorectal malformations. Orphanet J Rare Dis 2007; 2: 33
  • 2 DeVries PA. The surgery of anorectal anomalies: its evolution, with evaluations of procedures. Curr Probl Surg 1984; 21 (05) 1-75
  • 3 Peña A, Devries PA. Posterior sagittal anorectoplasty: important technical considerations and new applications. J Pediatr Surg 1982; 17 (06) 796-811
  • 4 Okada A, Kamata S, Imura K. et al. Anterior sagittal anorectoplasty for rectovestibular and anovestibular fistula. J Pediatr Surg 1992; 27 (01) 85-88
  • 5 Aziz MA, Banu T, Prasad R, Khan AR. Primary anterior sagittal anorectoplasty for rectovestibular fistula. Asian J Surg 2006; 29 (01) 22-24
  • 6 Hashizume N, Asagiri K, Fukahori S. et al. Functional assessment of the patients with perineal and vestibular fistula treated by anterior sagittal anorectoplasty. Afr J Paediatr Surg 2018; 15 (01) 36-41
  • 7 Wang C, Li L, Liu S. et al. The management of anorectal malformation with congenital vestibular fistula: a single-stage modified anterior sagittal anorectoplasty. Pediatr Surg Int 2015; 31 (09) 809-814
  • 8 Wakhlu A, Kureel SN, Tandon RK, Wakhlu AK. Long-term results of anterior sagittal anorectoplasty for the treatment of vestibular fistula. J Pediatr Surg 2009; 44 (10) 1913-1919
  • 9 Zamir N, Mirza FM, Akhtar J, Ahmed S. Anterior sagittal approach for anorectal malformations in female children: early results. J Coll Physicians Surg Pak 2008; 18 (12) 763-767
  • 10 Gupta A, Agarwala S, Sreenivas V, Srinivas M, Bhatnagar V. Primary definitive procedure versus conventional three-staged procedure for the management of low-type anorectal malformation in females: a randomized controlled trial. J Indian Assoc Pediatr Surg 2017; 22 (02) 87-91
  • 11 Li L, Ren X, Ming A. et al. Laparoscopic-assisted anorectoplasty for intermediate type rectovestibular fistula: a preliminary report. Pediatr Surg Int 2020; 36 (10) 1213-1219
  • 12 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
  • 13 Kulshrestha S, Kulshrestha M, Singh B, Sarkar B, Chandra M, Gangopadhyay AN. Anterior sagittal anorectoplasty for anovestibular fistula. Pediatr Surg Int 2007; 23 (12) 1191-1197
  • 14 Shehata SM. Prospective long-term functional and cosmetic results of ASARP versus PASRP in treatment of intermediate anorectal malformations in girls. Pediatr Surg Int 2009; 25 (10) 863-868
  • 15 Peña A, Hong A. Advances in the management of anorectal malformations. Am J Surg 2000; 180 (05) 370-376
  • 16 Holschneider A, Hutson J, Peña A. et al. Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations. J Pediatr Surg 2005; 40 (10) 1521-1526
  • 17 Bischoff A, Bealer J, Peña A. Critical analysis of fecal incontinence scores. Pediatr Surg Int 2016; 32 (08) 737-741
  • 18 Heinen FL. The surgical treatment of low anal defects and vestibular fistulas. Semin Pediatr Surg 1997; 6 (04) 204-216
  • 19 Rintala RJ, Lindahl HG, Rasanen M. Do children with repaired low anorectal malformations have normal bowel function?. J Pediatr Surg 1997; 32 (06) 823-826
  • 20 Li L, Ren X, Ming A. et al. Laparoscopic surgical technique to enhance the management of anorectal malformations: 330 cases' experience in a single center. Pediatr Surg Int 2020; 36 (03) 279-287
  • 21 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 , discussion 930–931
  • 22 Lombardi L, Bruder E, Caravaggi F, Del Rossi C, Martucciello G. Abnormalities in “low” anorectal malformations (ARMs) and functional results resecting the distal 3 cm. J Pediatr Surg 2013; 48 (06) 1294-1300
  • 23 Xiao H, Huang R, Cui DX, Xiao P, Diao M, Li L. Histopathologic and immunohistochemical findings in congenital anorectal malformations. Medicine (Baltimore) 2018; 97 (31) e11675
  • 24 Pena A. Female defects. In: Pena A. ed. Atlas of Surgical Management of Anorectal Malformations. New York: Springer-Verlag; 1989: 50-55
  • 25 Levitt MA, Pena A. Operative management of anomalies in the female. In: Hohlschneider AM, Hustson JM. eds. Anorectal Malformations in Children. Berlin, Heidelberg: Springer; 2006: 303-305
  • 26 Jung SM, Lee SK, Seo JM. Experience with laparoscopic-assisted anorectal pull-through in 25 males with anorectal malformation and rectourethral or rectovesical fistulae: postoperative complications and functional results. J Pediatr Surg 2013; 48 (03) 591-596
  • 27 Al-Hozaim O, Al-Maary J, AlQahtani A, Zamakhshary M. Laparoscopic-assisted anorectal pull-through for anorectal malformations: a systematic review and the need for standardization of outcome reporting. J Pediatr Surg 2010; 45 (07) 1500-1504