The Role of Laparoscopy in Anorectal Malformations

Rebecca M. Rentea; Devin R. Halleran; Richard J. Wood; Marc A. Levitt

doi:10.1055/s-0040-1701700

European Journal of Pediatric Surgery, Table of Contents

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

¹Comprehensive Colorectal Center, Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States

,

Devin R. Halleran

²Center for Colorectal and Pelvic Reconstruction, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States

,

Richard J. Wood

²Center for Colorectal and Pelvic Reconstruction, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States

,

Marc A. Levitt

³Department of Pediatric Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States

› Author Affiliations

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

Full Text

References

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