Minimally invasive surgery for anorectal malformation in boys: a multicenter study.
BACKGROUND
The laparoscopic pull-through for high imperforate anus in boys has recently been developed in France and Benelux. The purpose of this study was to evaluate technical difficulties and surgical complications of this approach.


METHODS
This report was based on a retrospective study from January 2002 to December 2007,including 34 patients from 10 centers. The rectourinary fistula found in 33/34 cases was bulbar in 10, prostaticin 20, and cervical in 3.


RESULTS
Patients were 3.7 months old (range, 1.6-10.4) at surgery. Fistula was cut without closure in 11 cases or divided and closed on the genitourinary side with a suture in 15, with clips in five and linear stapler in two.Median operative duration was 152 mm (range, 80-410). The main per-operative complication, occurring in five cases, was leakage of stools from the rectum after the fistula section, requiring in one case a second laparoscopic procedure for washing and for all five cases intravenous antibiotics. Median hospital stay was 6 days(range, 3-15). During the follow-up, patients experienced eight anal stenoses and three prolapses, requiring in three cases perineal redo surgery.


CONCLUSIONS
The laparoscopic approach of high imperforate anus allowed an easy control of the fistula and helped to determine the accurate passage through the levator ani. Nevertheless, technical points have to be improved,such as coprostasis before fistula section to avoid stool leakage, rectum tacking to prevent prolapse,and calibration of muscle channel to avoid stenosis.
Podevin
Guillaume
G
Department of Pediatric Surgery, CHU-HME, Nantes, France. guillaume.podevin@chu-nantes.fr
Petit
Thierry
T
Mure
Pierre Yves
PY
Gelas
Thomas
T
Demarche
Martine
M
Allal
Hossein
H
Becmeur
François
F
Varlet
François
F
Philippe
Paul
P
Weil
Dominique
D
Heloury
Yves
Y
D001006:Anus, Imperforate / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D014548:Urinary Fistula / Q000601:surgery