title: Laparoscopically assisted anorectovaginoplasty for selected types of female anorectal malformations.
abstract: 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.
authors.affiliation: Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Eri
authors.initials: E
authors.lastname: Tei
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
authors.forename: Osamu
authors.initials: O
authors.lastname: Segawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tobayama
authors.forename: Shingo
authors.initials: S
authors.lastname: Kameoka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyano
mesh_terms: 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