title: Laparoscopy-assisted anorectal pull-through in anorectal malformations: a reappraisal.
abstract: BACKGROUND
  Anorectal malformation is a complex anomaly with a broad variety of expressions. There are different techniques available for correction of the anomaly, all with their specific morbidity. Recently, much attention has been paid to acquired posterior urethral diverticulum after correction of anorectal malformation. The aim of this retrospective study was to reappraise the laparoscopic approach to correction of the anorectal malformation with respect to what can be prevented and what can be improved.
  
  
  METHODS
  Between July 2000 and July 2011, a total of 19 boys born with a high or intermediate anorectal malformation were admitted to our center. All patients underwent a diagnostic workup and were included in the follow-up protocol. Follow-up continence was scored according to the Krickenbeck criteria. Patients were also invited for an ultrasound and micturition cystourethrogram (MCUG) at follow-up to determine or exclude the presence of a posterior urethral diverticulum.
  
  
  RESULTS
  All patients underwent a successful laparoscopy-assisted anorectal pull-through. Mean age at the time of surgery was 2.5 months. Mean length of hospital stay was 5 days. Mean follow-up was 73 months. Complications were encountered in six patients. At follow-up 53 % of all our patients had spontaneous bowel movements and 41 % needed the help of laxatives or rectal washouts. In three patients a residual blind ending fistula was determined on MCUG but there was no true diverticulum.
  
  
  CONCLUSIONS
  Correction of anorectal malformation is a complex procedure with significant morbidity. Refinements of the technique may prevent complications and improve outcome in both the laparoscopic and posterior sagittal anorectoplasty. Acquired posterior urethral diverticulum does not necessarily need to occur more often with the laparoscopic approach.
authors.affiliation: Department of Pediatric Surgery, KE.04.140.5, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands. d.c.vanderzee@umcutrecht.nl
authors.forename: David C
authors.initials: DC
authors.lastname: van der Zee
authors.forename: Pieter
authors.initials: P
authors.lastname: Dik
authors.forename: Frederik J
authors.initials: FJ
authors.lastname: Beek
mesh_terms: D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies
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