Intraoperative endosonography enhances laparoscopy-assisted colon pull-through for high imperforate anus.
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.
Yamataka
Atsuyuki
A
Departments of Pediatric Surgery and Radiology, Juntendo University School of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Yoshida
Ryuji
R
Kobayashi
Hiroyuki
H
Lane
Geoffrey J
GJ
Kurosaki
Yoshihisa
Y
Segawa
Osamu
O
Kameoka
Shingo
S
Miyano
Takeshi
T
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