title: Is intraoperative anal endosonography necessary during laparoscopy-assisted anorectoplasty for high/intermediate type imperforate anus?
abstract: OBJECTIVE
  The aim of this study was to evaluate the relevance of anal endosonography (AES) during Georgeson laparoscopy-assisted anorectoplasty (GLA) for high/intermediate type imperforate anus (HIIA) using a continence evaluation questionnaire (CEQ) and postoperative AES (post-AES).
  
  
  METHODS
  Fifteen HIIA patients who underwent GLA were enrolled in this prospective study. Six had intraoperative AES (op-AES) to confirm the accuracy of the positioning of the pull-through (PT) canal and 9 did not (no-AES). All subjects were reviewed prospectively by one surgeon and all had post-AES to measure the external sphincter (ES) and puborectalis (PR) at 3 and 9 o'clock to confirm that the PT colon was central. A CEQ (5 parameters: frequency of motions, severity of staining, severity of perianal erosions, anal shape, and requirement for medications; maximum score: 10) was administered to 9 subjects (4 from op-AES and 5 from no-AES) followed-up for over 3 years to assess continence.
  
  
  RESULTS
  Mean age at GLA for both groups was not statistically different. There were no statistical differences between the two groups for thickness of the ES and PR on post-AES. Mean annual CEQ scores for the op-AES group 1, 2, 3, 4, and 5 years after GLA were 5.3, 6.3, 7.4, 8.4, and 8.5, respectively, while for the no-AES group were 5.9, 7.1, 8.1, 8.2, and 8.2, respectively; all differences were not statistically significant.
  
  
  CONCLUSIONS
  Our results suggest that op-AES is not necessary during GLA because there is no difference in clinical and functional status that can be attributed to op-AES.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Watayo
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kaneyama
authors.forename: Chizue
authors.initials: C
authors.lastname: Ichijo
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D001006:Anus, Imperforate / Q000601:surgery*; D019160:Endosonography; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012007:Rectum / Q000601:surgery*