title: Comparison of outcomes between laparoscopy-assisted and posterior sagittal anorectoplasties for male imperforate anus with recto-bulbar fistula.
abstract: OBJECTIVE
  All reports comparing laparoscopy-assisted anorectoplasty (LAARP) with posterior sagittal anorectoplasty (PSARP) in male high-type imperforate anus include a mix of recto-vesical, recto-prostatic, recto-bulbar, and absent fistula cases without focusing on recto-bulbar fistula (RBF), the most challenging type to treat laparoscopically. We compared LAARP with PSARP for treating only RBF.
  
  
  METHODS
  We used our fecal continence evaluation questionnaire (FCE; maximum score=10), scoring of magnetic resonance imaging (MRI) findings (MRI scores), and the angle between the rectum and the anal canal (RAA) to assess 20 RBF cases (LAARP=12, PSARP=8) treated from 2000 to 2013 prospectively.
  
  
  RESULTS
  Mean ages at surgery, MRI scores, mean RAA, and duration of raised C-reactive protein (6.6 vs. 6.7days; p=NS) were similar. In all cases, postoperative MRI showed no residual fistula and normal urination. LAARP had consistently higher FCE (7.9 vs. 7.8 at 3years; 8.6 vs. 8.3 at 5years; 8.9 vs 8.6 at 7years; p=NS, respectively), less wound infections (0 vs. 37.5%; p<0.05), higher incidence of rectal mucosal prolapse (50.0 vs. 0%; p<0.05), and required less analgesia (p<0.05).
  
  
  CONCLUSIONS
  Although LAARP and PSARP are comparable for treating RBF, LAARP is associated with less wound infections and higher incidence of rectal mucosal prolapse.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo Japan. Electronic address: h-koga@juntendo.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Ochi
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo Japan.
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo Japan.
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D000015:Abnormalities, Multiple; D001006:Anus, Imperforate / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012003:Rectal Fistula / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000601:surgery*
keywords: Imperforate anus; Laparoscopy-assisted anorectoplasty; Posterior sagittal anorectoplasty; Recto-bulbar fistula