title: Intraoperative endosonography enhances laparoscopy-assisted colon pull-through for high imperforate anus.
abstract: OBJECTIVE
  The authors used ultrasonographic endoprobes during laparoscopy-assisted colon pull-through (LACPT) for the repair of high imperforate anus to confirm the pull-through canal was surrounded symmetrically by pelvic floor muscles.
  
  
  METHODS
  Six patients with high imperforate anus were treated by LACPT (mean age at LACPT, 8.2 months). An endoscopic (12-MHz, 2.5-mm in diameter) and proctoscopic (7.5-MHz, 12-mm in diameter) probe were inserted into the proposed route of dissection intraoperatively to measure the thickness of the surrounding muscle tissue at at least 3 levels: the external anal sphincter, the levator ani muscle sling, and the intervening muscle complex.
  
  
  RESULTS
  The average thickness of the external anal sphincter was 2.3 +/- 0.4 mm anteriorly, 2.4 +/- 0.4 mm on the left, 2.4 +/- 0.5 mm posteriorly, and 2.6 +/- 0.6 mm on the right. The average thickness of the muscle complex was 2.3 +/- 0.6 mm anteriorly, 2.2 +/- 0.5 mm on the left, 2.1 +/- 0.4 mm posteriorly, and 2.2 +/- 0.5 mm on the right. The average thickness of the left crus of the levator ani muscle was 1.8 +/- 0.3 mm, the right crus was 1.9 +/- 0.4 mm, and the rim located posterior to the rectum was 2.0 +/- 0.3 mm. No statistically significant difference was found between the measurements taken at each level.
  
  
  CONCLUSIONS
  Intraoperative endosonography during LACPT can greatly enhance the precision of positioning the pull-through canal.
authors.affiliation: Departments of Pediatric Surgery and Radiology, Juntendo University School of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
authors.forename: Ryuji
authors.initials: R
authors.lastname: Yoshida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kurosaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Segawa
authors.forename: Shingo
authors.initials: S
authors.lastname: Kameoka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyano
mesh_terms: D001006:Anus, Imperforate / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D011182:Postoperative Care; D016896:Treatment Outcome