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Article: Laparoscopic surgical technique to enhance the management of anorectal malformations: 330 cases’ experience in a single center

TitleLaparoscopic surgical technique to enhance the management of anorectal malformations: 330 cases’ experience in a single center
Authors
KeywordsLaparoscopic-assisted anorectoplasty
High-type anorectal malformation
Intermediate-type anorectal malformation
Sphincter muscle complex
Long-term outcomes
Issue Date2020
PublisherSpringer Verlag. The Journal's web site is located at http://link.springer.de/link/service/journals/00383/index.htm
Citation
Pediatric Surgery International, 2020, v. 36 n. 3, p. 279-287 How to Cite?
AbstractPurpose: Laparoscopic-assisted anorectoplasty (LAARP) is considered to benefit the patients with vesico-prostatic fistula. The aim of this study is to present the details of our LAARP technique for improving the short- and long-term outcomes in the patients with high and intermediate types of anorectal malformations (ARMs). Methods: 330 patients with high-type (174 cases) and intermediate-type (156 cases) anorectal malformation (aged 8 days to 15 years) underwent LAARP from 2001 to 2019. LAARP was performed for full mobilization and resection of the dilated rectum, intra-rectal closure of the fistula, visualization, and enlargement of the center of the longitudinal muscle tube (LMT) from pelvic and perineal aspects. Results: LAARP was performed in all patients and no patient was converted to open procedure. The urethral diverticulum was found in three patients (1.02%, 3/294) according to postoperative protocol voiding cystourethrogram but was not associated with any symptoms such as urinary tract infection and dysuria. Rectal prolapse requiring surgical intervention developed in 25 (7.6%) of 330 patients. Anal stricture occurred in three patients and re-do anoplasty was performed 5 months after LAARP. Anal retraction occurred in two patients and re-pull-through was conducted at 5 and 6 days, respectively, after LAARP. 228 patients who were older than 3 years were followed up. The median follow-up period was 5.8 years (range 3–15 years). 217 patients (95.2%) had voluntary bowel movements; 202 patients (88.6%) were free from soiling or with grade 1 soiling; 30 patients (13.6%) and 25 patients (11.3%) suffered from grade 1 and grade 2 constipation, respectively, while no patient had grade 3 constipation. Conclusion: Our experience demonstrates that the LAARP has advantages on rectal mobilization and resection, intra-rectal fistula closure and accurate tunnel formation in the LMT with minimal trauma. The improvement of the short-term and long-term outcomes after LAARP has been shown not only for high-type ARM but also for intermediate-type ARM.
Persistent Identifierhttp://hdl.handle.net/10722/282015
ISSN
2019 Impact Factor: 1.668
2015 SCImago Journal Rankings: 0.409
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLi, L-
dc.contributor.authorRen, X-
dc.contributor.authorMing, A-
dc.contributor.authorXu, H-
dc.contributor.authorSun, R-
dc.contributor.authorZhou, Y-
dc.contributor.authorLiu, X-
dc.contributor.authorSun, H-
dc.contributor.authorLi, Q-
dc.contributor.authorLi, X-
dc.contributor.authorZhang, Z-
dc.contributor.authorCheng, W-
dc.contributor.authorDiao, M-
dc.contributor.authorTam, PKH-
dc.date.accessioned2020-04-19T03:34:10Z-
dc.date.available2020-04-19T03:34:10Z-
dc.date.issued2020-
dc.identifier.citationPediatric Surgery International, 2020, v. 36 n. 3, p. 279-287-
dc.identifier.issn0179-0358-
dc.identifier.urihttp://hdl.handle.net/10722/282015-
dc.description.abstractPurpose: Laparoscopic-assisted anorectoplasty (LAARP) is considered to benefit the patients with vesico-prostatic fistula. The aim of this study is to present the details of our LAARP technique for improving the short- and long-term outcomes in the patients with high and intermediate types of anorectal malformations (ARMs). Methods: 330 patients with high-type (174 cases) and intermediate-type (156 cases) anorectal malformation (aged 8 days to 15 years) underwent LAARP from 2001 to 2019. LAARP was performed for full mobilization and resection of the dilated rectum, intra-rectal closure of the fistula, visualization, and enlargement of the center of the longitudinal muscle tube (LMT) from pelvic and perineal aspects. Results: LAARP was performed in all patients and no patient was converted to open procedure. The urethral diverticulum was found in three patients (1.02%, 3/294) according to postoperative protocol voiding cystourethrogram but was not associated with any symptoms such as urinary tract infection and dysuria. Rectal prolapse requiring surgical intervention developed in 25 (7.6%) of 330 patients. Anal stricture occurred in three patients and re-do anoplasty was performed 5 months after LAARP. Anal retraction occurred in two patients and re-pull-through was conducted at 5 and 6 days, respectively, after LAARP. 228 patients who were older than 3 years were followed up. The median follow-up period was 5.8 years (range 3–15 years). 217 patients (95.2%) had voluntary bowel movements; 202 patients (88.6%) were free from soiling or with grade 1 soiling; 30 patients (13.6%) and 25 patients (11.3%) suffered from grade 1 and grade 2 constipation, respectively, while no patient had grade 3 constipation. Conclusion: Our experience demonstrates that the LAARP has advantages on rectal mobilization and resection, intra-rectal fistula closure and accurate tunnel formation in the LMT with minimal trauma. The improvement of the short-term and long-term outcomes after LAARP has been shown not only for high-type ARM but also for intermediate-type ARM.-
dc.languageeng-
dc.publisherSpringer Verlag. The Journal's web site is located at http://link.springer.de/link/service/journals/00383/index.htm-
dc.relation.ispartofPediatric Surgery International-
dc.subjectLaparoscopic-assisted anorectoplasty-
dc.subjectHigh-type anorectal malformation-
dc.subjectIntermediate-type anorectal malformation-
dc.subjectSphincter muscle complex-
dc.subjectLong-term outcomes-
dc.titleLaparoscopic surgical technique to enhance the management of anorectal malformations: 330 cases’ experience in a single center-
dc.typeArticle-
dc.identifier.emailTam, PKH: paultam@hku.hk-
dc.identifier.authorityTam, PKH=rp00060-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s00383-019-04614-x-
dc.identifier.pmid31919580-
dc.identifier.scopuseid_2-s2.0-85077708132-
dc.identifier.hkuros309729-
dc.identifier.volume36-
dc.identifier.issue3-
dc.identifier.spage279-
dc.identifier.epage287-
dc.identifier.isiWOS:000512695600003-
dc.publisher.placeGermany-

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