Laparoscopically assisted anorectovaginoplasty for selected types of female anorectal malformations.
OBJECTIVE
The aim of this study was to describe laparoscopically assisted anorectovaginoplasty (LAARVP) for the repair of selected types of female anorectal malformation.


METHODS
Five cases (case 1, rectovaginal fistula with a high rectum; case 2, rectovestibular fistula with double vagina; case 3, rectovestibular fistula with absent vagina; case 4, anovestibular fistula with absent vagina; case 5, cloaca) were reviewed.


RESULTS
Patient 4 had undergone a posterior sagittal anorectoplasty without vaginoplasty at another hospital after misdiagnosis of simple anovestibular fistula. Mean age at LAARVP was 15.4 months. At LAARVP, the fistula was divided in cases 1 through 4 and dissected as low as possible in case 5. In cases 3 and 4, the distal fistula was used to create the neovagina. In cases 1 through 3, the proximal rectum was mobilized and brought through the pelvic floor sphincter muscles using Georgeson's laparoscopically assisted colon pull-through technique through a minimal perineal incision. A posterior sagittal incision was required in cases 4 and 5. However, the initial laparoscopic approach was very helpful in both cases. Currently, all patients are well after a mean follow-up period of 32.2 months. Mean current age is 4.0 years. Patients 1 through 3 are continent, patient 4 is incontinent with soiling, and patient 5 is too young to be evaluated.


CONCLUSIONS
LAARVP helps to achieve low dissection of the fistula, gives optimal view of the pelvic organs, provides accurate placement of the anorectal pull-through, and minimizes abdominal perineal scars.
Tei
Eri
E
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Yamataka
Atsuyuki
A
Segawa
Osamu
O
Kobayashi
Hiroyuki
H
Lane
Geoffrey J
GJ
Tobayama
Shigeru
S
Kameoka
Shingo
S
Miyano
Takeshi
T
D001003:Anal Canal / Q000002:abnormalities / Q000601:surgery; D002988:Cloaca / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D012003:Rectal Fistula / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D001747:Urinary Bladder Fistula / Q000601:surgery*; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery