title: Laparoscopic repair of anorectal malformations at the Red Cross War Memorial Children's Hospital: taking stock.
abstract: BACKGROUND
  The current standard repair for anorectal malformations in children is a posterior sagittal anorectoplasty. Recently, laparoscopic-assisted anorectoplasty (LAARP) was performed at the Red Cross Children's Hospital.
  
  
  METHODS
  A detailed case note review was conducted. Patient outcome was prospectively evaluated by colorectal nurse specialists using the Krickenbeck standardized questionnaire. Comparison among patients undergoing posterior sagittal anorectoplasty was performed.
  
  
  RESULTS
  Between September 2005 and June 2009, 24 children underwent LAARP. Sixteen had associated anomalies, including 7 children with renal and 4 children with cardiac abnormalities. Median age at surgery was 7.5 months (range, 2.6-15.0 months). Subtypes of anorectal malformation were as follows: vestibular, 2; bulbar, 9; prostatic, 7; vesical, 3; and with no fistula, 3. There was a 16% early complication rate. Redo-anoplasty was required in 9 patients. Eleven children had difficulties with follow-up. Thirteen children had regular follow-up and were analyzed further. Toilet training had been completed in 7 children (median age, 4.3 years; range, 3.5-6 years). Six children developed voluntary bowel motions. Six children are awaiting toilet training or are unable to train because of incontinence.
  
  
  CONCLUSIONS
  Anal stenosis was the most common complication post-LAARP. Etiology appeared to be multifactorial, but poor compliance with dilatations was a leading cause.
authors.affiliation: Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town 7700, South Africa. r.england@doctors.org.uk
authors.forename: Richard J
authors.initials: RJ
authors.lastname: England
authors.forename: Sara L
authors.initials: SL
authors.lastname: Warren
authors.forename: Lorraine
authors.initials: L
authors.lastname: Bezuidenhout
authors.forename: Alp
authors.initials: A
authors.lastname: Numanoglu
authors.forename: Alastair J W
authors.initials: AJ
authors.lastname: Millar
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012007:Rectum / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome