title: Long term outcomes of laparoscopic-assisted anorectoplasty: a comparison study with posterior sagittal anorectoplasty.
abstract: OBJECTIVE
  The aim of this study is to compare the long term outcomes between laparoscopic-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) for children with rectobladderneck and rectoprostatic fistula anorectal malformations (ARM).
  
  
  METHODS
  Thirty-two ARM children with rectobladderneck and rectoprostatic fistula who underwent LAARP between October 2001 and March 2012 were reviewed. The outcomes were compared with those of 34 ARM children who underwent PSARP between August 1992 and September 2001. The sacral ratio (SR), age at operation, operative time, postoperative hospital stay and complications were evaluated. Bowel functions were assessed using the Krickenbeck classification.
  
  
  RESULTS
  The mean operative time of the LAARP was significantly shorter than that of PSARP group (1.62 ± 0.40 vs 2.13 ± 0.30 h). The postoperative hospital stay was significantly shorter in the LAARP group (5.8 ± 0.65 vs 8.4 ± 0.67 h). The wound infections (11.8% vs 0%) and recurrent fistula (11.8% vs 0%) were more common in PSARP patients. Th e overall morbidity rate of PSARP group was significantly higher than that of the LAARP group (35.3% vs 12.5%, p<0.05). However, 7.5% of the LAARP patients developed rectal prolapse. Twenty-four of 32 patients were followed up for more than 3 years in LAARP group. The median follow up period was 7.5 years (range 4-11) in LAARP patients and 15.5 years (range 11-20) in PSARP patients. The rates of voluntary bowel movement, soiling (grade 1, 2 & 3) were similar in both groups. More patients from PSARP group developed grade 2 or 3 constipation (22.5% vs 0%, P<0.01).
  
  
  CONCLUSIONS
  Compared to PSARP, LAARP is a less invasive procedure. The long term functional outcomes after LAARP were equivalent if not better than those of PSARP.
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, P. R. China.
authors.forename: An-Xiao
authors.initials: AX
authors.lastname: Ming
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, P. R. China. Electronic address: lilong22@hotmail.com.
authors.forename: Long
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, P. R. China.
authors.forename: Mei
authors.initials: M
authors.lastname: Diao
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, P. R. China.
authors.forename: Hai-Bin
authors.initials: HB
authors.lastname: Wang
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, P. R. China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, P. R. China.
authors.forename: Mao
authors.initials: M
authors.lastname: Ye
authors.affiliation: Department of Paediatric Surgery, Monash Children's, Monash Medical Center, Southern Health, Department of Paediatrics and Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia. Electronic address: wei.cheng@monash.edu.
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D001003:Anal Canal / Q000002:abnormalities / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011469:Prostatic Diseases / Q000151:congenital / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012003:Rectal Fistula / Q000151:congenital / Q000601:surgery*; D012007:Rectum / Q000002:abnormalities / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D001747:Urinary Bladder Fistula / Q000151:congenital / Q000601:surgery*
keywords: Anorectal malformation; Functional evaluation; Laparoscope; Recto-bladderneck and recto-prostatic fistula