title: Laparoscopically assisted anorectal pull-through for high imperforate anus in infants: intermediate results.
abstract: OBJECTIVE
  The aim of this study was to evaluate the clinical outcomes and postoperative anal function in infants with congenital high imperforate anus treated with laparoscopically assisted anorectal pull-through (LAARP).
  
  
  METHODS
  From January 2004 to July 2007, 33 patients (28 boys and 5 girls, age ranging from 3 to 10 months) with high imperforate anus underwent LAARP. Clinical data of the LAARP group were retrospectively compared with those treated by posterior sagittal anorectoplasty (PSARP; n = 28) during the same time period. Anorectal function of these patients was evaluated using the following 3 methods: the Kelly score, anorectal vector volume manometry, and magnetic resonance imaging between the ages of 3.1 and 4.4 years.
  
  
  RESULTS
  The mean operative time in LAARP and PSARP groups was 112.5 ± 12.4 and 120.4 ± 18.5 minutes (P > .05), respectively. The mean length of hospital stay in the LAARP group was shorter than that of PSARP group (11.3 ± 2.1 vs 14.6 ± 2.3 days, P < .01). No significant difference was observed between LAARP and PSARP groups regarding the Kelly score (3.52 ± 1.42 vs 3.49 ± 0.82). Although magnetic resonance imaging revealed lower malposition rates of rectum in the LAARP group than those of the PSARP group at both I-line (3.0% vs 14.3%) and M-line (3.0% vs 10.7%) levels, this was not statistically different (P > .05). Compared with the PSARP group, lower asymmetric index, larger vector volume, and higher anal canal pressure at rest and during voluntary squeeze were observed in LAARP group (P < .05). However, there were no significant differences in the length of high-pressure zone (15.2 ± 5.8 vs 15.1 ± 6.2 mm) and the presence of rectoanal relaxation reflex (84.8% vs 85.7%).
  
  
  CONCLUSIONS
  Satisfactory fecal continence can be achieved in patients with high-type imperforate anus after LAARP. Laparoscopically assisted anorectal pull-through has advantages over PSARP, including shorter hospital stay and better position of rectum. However, long-term follow-up is necessary to compare the benefits of LAARP against PSARP.
authors.affiliation: Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, PR China.
authors.forename: Qiang-song
authors.initials: QS
authors.lastname: Tong
authors.forename: Shao-tao
authors.initials: ST
authors.lastname: Tang
authors.forename: Jia-rui
authors.initials: JR
authors.lastname: Pu
authors.forename: Yong-zhong
authors.initials: YZ
authors.lastname: Mao
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.forename: Shi-wang
authors.initials: SW
authors.lastname: Li
authors.forename: Quo-qing
authors.initials: QQ
authors.lastname: Cao
authors.forename: Qing-lan
authors.initials: QL
authors.lastname: Ruan
mesh_terms: D001003:Anal Canal / Q000502:physiology; D001006:Anus, Imperforate / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008297:Male; D008365:Manometry; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function; D012007:Rectum / Q000502:physiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome