title: Residual fistula after laparoscopically assisted anorectoplasty: is it a rare problem?
abstract: OBJECTIVE
  Although various urologic complications have been reported after abdominoperineal pull-through and posterior sagittal anorectoplasty for the treatment of high-type imperforate anus, reports regarding complications after laparoscopically assisted anorectoplasty (LAARP) are surprisingly rare. Here, we discuss the potential complications of LAARP.
  
  
  METHODS
  A retrospective study was conducted of 24 patients treated with LAARP from 2000 to 2006. The clinical and operative records were reviewed. Of the 24 patients, 18 were evaluated postoperatively by screening magnetic resonance imaging (MRI).
  
  
  RESULTS
  The 24 participants are composed of patients with rectoprostatic urethral fistula (n = 15), rectal agenesis (n = 3), rectovesical fistula (n = 2), rectovaginal fistula (n = 2), and cloaca (n = 2). Defecatory function after LAARP was satisfactory. None of the patients had dysuria or urinary infection postoperatively. Cystic formations posterior to the urethra were demonstrated in 9 of the 18 cases examined by MRI. Postoperative voiding cystourethrography failed to demonstrate the lesion in 6 of 9 patients. The types of imperforate anus in this subgroup were rectoprostatic urethral fistula (n = 7), rectovesical fistula (n = 1), and rectal agenesis without fistula (n = 1). Average cyst diameter was 22 +/- 19 mm. Two patients with large cysts (62 and 42 mm) underwent surgical resection.
  
  
  CONCLUSIONS
  Although satisfactory fecal continence could be achieved by LAARP, we experienced 2 cases with a large residual fistula that required surgical resection. In addition, screening MRI demonstrated the presence of cystic formations in 9 of 18 patients. We recommend that MRI be performed routinely during follow-up of patients treated with LAARP.
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan. a2005136@pref.saitama.lg.jp
authors.forename: Hiroo
authors.initials: H
authors.lastname: Uchida
authors.forename: Tadashi
authors.initials: T
authors.lastname: Iwanaka
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kitano
authors.forename: Sumi
authors.initials: S
authors.lastname: Kudou
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ishimaru
authors.forename: Katsumi
authors.initials: K
authors.lastname: Yotsumoto
authors.forename: Chikashi
authors.initials: C
authors.lastname: Gotoh
authors.forename: Mariko
authors.initials: M
authors.lastname: Yoshida
mesh_terms: D001006:Anus, Imperforate / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D012003:Rectal Fistula / Q000175:diagnosis / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D014548:Urinary Fistula / Q000175:diagnosis / Q000601:surgery*