title: Single-incision laparoscopic-assisted anorectoplasty using conventional instruments for children with anorectal malformations and rectourethral or rectovesical fistula.
abstract: BACKGROUND
  This study aims to evaluate the safety and efficacy of single-incision laparoscopic-assisted anorectoplasty (SILAARP) for children with anorectal malformations (ARM) and rectourethral or rectovesical fistula.
  
  
  METHODS
  Children with ARMs and rectourethral or rectovesical fistula who underwent SILAARP between May 2011 and December 2012 were reviewed. The operative time, early postoperative and follow-up results were analyzed.
  
  
  RESULTS
  Thirty-one patients (ARM with rectovesical vs. rectoprostatic fistula vs. rectobulbar fistula: 9/6/16) successfully underwent SILAARPs without conversions. Mean ages at operation were similar in 2 groups (ARM with rectovesical or rectoprostatic fistula vs. ARM with rectobulbar fistula: 4.94 months vs. 5.67 months, p=0.46). Average operative time in ARM children with rectobulbar fistula was 1.94 hours, which did not differ from 1.78 hours in ARM children with rectovestical or rectoprostatic fistula (p=0.39). All patients resumed feeding on postoperative day 1. The median follow-up period was 20 months. No injuries of vessels, urethral or vas deferens occurred in operations. No mortality or morbidities of wound infection, rectal retraction, recurrent fistula, urethral diverticulum, anal stenosis, or rectal prolapse was encountered.
  
  
  CONCLUSIONS
  SILAARP is safe, feasible and effective for ARM with rectourethral or rectovesical fistula. One-stage SILAARP may offer a viable alternative treatment for ARM children with rectourethral or rectovesical fistula.
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. 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: Mao
authors.initials: M
authors.lastname: Ye
authors.affiliation: Department of Paediatrics and Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia; Department of Surgery, Beijing United Family Hospital, China. Electronic address: wei.cheng@monash.edu.
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
mesh_terms: D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011469:Prostatic Diseases / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012003:Rectal Fistula / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000601:surgery*; D001747:Urinary Bladder Fistula / Q000601:surgery
keywords: Anorectal malformations; Anorectoplasty; Children; Laparoscopy; Recto-urethral or rectovesical fistula; Single-incision