title: Anorectal anomalies in adults-laparoscopic management and review of literature.
abstract: Anorectal malformations (ARMs) are one of the most common congenital anomalies dealt by surgeons. The reported incidence of ARMs range between 1:3,300 and 1:5,000 live births. These defects are invariably detected and treated in infancy or early childhood. There is a group of patients among these who have fistulous external opening from the rectum. These may not present in child hood and may continue to live with fecal incontinence till adult hood. One of such anomalies is rectovaginal fistulas which comprises of only 4% of all anomalies. Delayed management in such cases increases surgical and functional complications. Traditionally high and intermediate anorectal anomalies are treated by posterior sagittal anorectoplasty (PSARP). This involves cutting of sphincter muscles in the midline and then placement of rectum in the sphincter complex. The continence results of this operation are less than ideal. Laparoscopically assisted anorectal pull-through (LAARP) has potential advantage of precise placement of the rectum inside the sphincter complex without dividing and weakening the muscles, diminished soft tissue scarring around the rectum leading to improved rectal compliance. Three adult female patients with ARMs were managed through LAARP procedure. It involves dissection around rectum, identification and ligation of fistula tract, creation of neoanus and pull through of rectum into neoanus. Results-Continence was good in all our patients which they regained after 3 to 4 days of surgery. On follow up which ranged from 6 months to 2 years all were passing well formed stools 1-2 times a day and have symmetric anal contraction with strong squeeze on digital rectal examination. Conclusion-LAARP offers an excellent option to the patients of ARM over conventional posterior sagittal anorectal approach because if its theoretical advantages of early recovery and better continence. Long term followup is needed to substantiate these results.
authors.affiliation: Department of Surgical Gastroenterology, Bangalore Medical College and Research Institute, Bangalore, India ; 67 B Tagore Nagar, Civil Lines, Ludhiana, Punjab 141001 India.
authors.forename: Ripan K
authors.initials: RK
authors.lastname: Miglani
authors.forename: Divakar
authors.initials: D
authors.lastname: Murthy
authors.forename: Ravi Shanker
authors.initials: RS
authors.lastname: Bhat
authors.forename: Kumar K V
authors.initials: KK
authors.lastname: Ashok
keywords: ARMs; Anorectal malformations; Congenital anomalies; LAARP; Laparoscopically assisted anorectal pull-through
references.citation: J Pediatr Surg. 1982 Oct;17(5):638-43
references.pmid: 7175658
references.citation: J Pediatr Surg. 1995 Mar;30(3):491-4
references.pmid: 7760250
references.citation: J Pediatr Surg. 2001 Nov;36(11):1659-61
references.pmid: 11685696
references.citation: Dis Colon Rectum. 1978 Nov-Dec;21(8):633-5
references.pmid: 738180
references.citation: J Pediatr Surg. 1987 Dec;22(12):1160-8
references.pmid: 3440904
references.citation: J Pediatr Surg. 2000 Jun;35(6):927-30; discussion 930-1
references.pmid: 10873037
references.citation: J Indian Assoc Pediatr Surg. 2008 Apr;13(2):64-8
references.pmid: 20011470
references.citation: Dis Colon Rectum. 1997 Sep;40(9):1119-23
references.pmid: 9293944
references.citation: J Pediatr Surg. 1987 Apr;22(4):335-48
references.pmid: 3572690