title: Intraoperative colonoscopy facilitates safe dissection of the rectal pouch in a case of male imperforate anus.
abstract: BACKGROUND
  In an imperforate anus, colostography often fails to identify recto-urethral fistula (RUF). Thus, surgeons must always assume an RUF is present, despite colostography findings, and dissect the distal rectal pouch (RP) with caution. We report the usefulness of intraoperative colonoscopy (IOC) for excluding RUF and, thus, facilitating safe dissection of the RP.
  
  
  METHODS
  We used IOC in six cases of imperforate anus. All had right transverse colostomy initially after birth. Distal colostography excluded RUF in five cases and was inconclusive in one. Laparoscopy was used to free the RP carefully from the bladder neck in all cases. Near the prostate, a 4-mm fine, flexible colonoscope was inserted into the RP through the anterior rectal wall to observe the laparoscopic dissection of the RP, which was attached closely to the prostate/bulbar urethra intraluminally to prevent injury to the urethra. The mucosa of the distal end of the RP was mucosectomized or diathermied, and the colon was pulled-through. Mean age at surgery was 11 months.
  
  
  RESULTS
  IOC excluded RUF under direct vision in all cases, which enabled the dissection of the RP to be monitored and to proceed smoothly. At follow-up (mean: 31 months), all cases were well.
  
  
  CONCLUSIONS
  IOC can be used to exclude RUF and facilitate safe dissection of the RP in imperforate anus.
authors: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors: A
authors: A
authors: Halibieke
authors: G
authors: G
authors: Miyano
authors: Y
authors: Y
authors: Kato
authors: H
authors: H
authors: Koga
authors: A
authors: A
authors: Shimotakahara
authors: Gj
authors: G
authors: Lane
authors: T
authors: T
authors: Okazaki
authors: M
authors: M
authors: Urao
authors: A
authors: A
authors: Yamataka
mesh_terms: D001006:Anus, Imperforate / Q000150:complications / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012003:Rectal Fistula / Q000150:complications / Q000175:diagnosis*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000150:complications / Q000175:diagnosis*; D014548:Urinary Fistula / Q000150:complications / Q000175:diagnosis*