title: Primary laparoscopic repair of high imperforate anus in neonatal males.
abstract: OBJECTIVE
  The standard approach to males with high imperforate anus has been a staged procedure starting with a descending colostomy, then posterior sagittal anorectoplasty with colostomy closure after 3 months. Recently, a minimally invasive approach to the repair of high imperforate anus has been described in infants after colostomy. We describe 6 newborn males with high imperforate anus successfully repaired laparoscopically as a primary, single-stage procedure.
  
  
  METHODS
  A retrospective chart review was performed on all patients with imperforate anus from October 2003 to October 2006.
  
  
  RESULTS
  We evaluated 9 newborn males with high imperforate anus. Of these patients, 6 underwent primary laparoscopic repair on day 1 to day 2 of life. Of these 6 patients, 3 were found to have bladder neck fistulas, whereas the other 3 had prostatic urethra fistulas. All patients passed stool within the first 72 hours postoperatively. One patient has required a procedure for a mild rectal prolapse. Follow-up ranges from 2 to 30 months in the single-stage group.
  
  
  CONCLUSIONS
  Our early results using primary laparoscopic repair appear encouraging. Laparoscopy allows excellent visualization and assessment of the fistula and repair of high imperforate anus without need for colostomy. Long-term follow-up will be needed to assess outcomes and continence rates.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA.
authors.forename: Laura R
authors.initials: LR
authors.lastname: Vick
authors.forename: John R
authors.initials: JR
authors.lastname: Gosche
authors.forename: Scott C
authors.initials: SC
authors.lastname: Boulanger
authors.forename: Saleem
authors.initials: S
authors.lastname: Islam
mesh_terms: D001006:Anus, Imperforate / Q000175:diagnosis / Q000601:surgery*; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome