Laparoscopic versus open abdominoperineal rectoplasty for infants with high-type anorectal malformation.
OBJECTIVE
There has not been any study comparing laparoscopic abdominoperineal rectoplasty (ARP) with open ARP. This study investigated the true benefits of the laparoscopic approach in infants with high anorectal malformation.


METHODS
A retrospective analysis was performed in 28 infants with high anorectal malformation treated between 1990 and 2007. Fifteen were treated by open ARP, and 13 were treated by laparoscopic ARP. Surgical durations, amount of bleeding, complications, anorectal pressure measurements, barium enema study, and clinical assessment were compared between the 2 groups.


RESULTS
The amount of intraoperative bleeding was significantly less in laparoscopic ARP (12 ± 11 g) than in open ARP (65 ± 44 g) (P = .003). Anal resting pressure was 34 ± 9 cm H(2)O after laparoscopic ARP and 31 ± 14 cm H(2)O after open ARP. Anorectal reflex was positive in 1 (7%) of 15 after open ARP and 3 (23%) of 13 after laparoscopic ARP. There was no significant difference in barium enema study and clinical assessment between the 2 groups. With regard to postoperative complications, mucosal prolapse occurred in 10 (67%) of 15 after open ARP and in none of 13 after laparoscopic ARP (P = .003).


CONCLUSIONS
Benefits of the laparoscopic approach were reduced intraoperative bleeding and a lower incidence of postoperative anal mucosal prolapse. These results indicate that minimal dissection of the mesorectum in laparoscopic ARP may provide those better outcomes.
Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. osamu@koto.kpu-m.ac.jp
Osamu
O
Kimura
Naomi
N
Iwai
Yasunari
Y
Sasaki
Tomoki
T
Tsuda
Eiichi
E
Deguchi
Shigeru
S
Ono
Taizo
T
Furukawa
D000293:Adolescent; D001003:Anal Canal / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D001466:Barium Sulfate; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000453:epidemiology; D004733:Enema; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D005402:Fistula / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D011183:Postoperative Complications / Q000453:epidemiology; D011469:Prostatic Diseases / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012003:Rectal Fistula / Q000601:surgery; D012006:Rectovaginal Fistula / Q000601:surgery; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D014522:Urethral Diseases / Q000601:surgery; D014548:Urinary Fistula / Q000601:surgery
D001466:Barium Sulfate