title: Outcome of Laparoscopic Treatment of Anorectal Malformations in Children.
abstract: Operative correction of anorectal malformations (ARMs) remains a challenge in pediatric surgery. The study aimed to evaluate the outcomes of laparoscopic treatment of ARM in children.
  
  
  
  From 2007 to 2014, we performed 104 laparoscopic-assisted anorectal pull-through procedures in children with a mean age of 11.3 ± 0.4 months and ARMs. Clinical assessment, surgical durations, complications, and postoperative outcome were investigated.
  
  
  
  The mean duration of the operation was 126.5 ± 17.2 min. Mean intraoperative bleeding was 20 ± 5.7 g. Three (2.9 %) children required conversion to laparotomy. One (0.9 %) child developed a pelvic abscess, requiring an additional intervention. Three to six months after laparoscopic-assisted anorectal pull-through, 72 patients were hospitalized for stoma closure. Good functional results were achieved in 39 (54.2 %) patients. On examination of the perineum, 11 (15.3 %) patients were found to have mucosal prolapse. The circular symmetric anal reflex to tactile stimulation was confirmed in 53 (73.6 %) patients and a tactile weakened anal reflex in 5 (6.9 %) children. At the 1-year follow-up, constipation was present in nine (12.5 %) patients and soling in two (2.8 %) patients. A barium enema study performed after the operation showed good outcomes in 67 (93.1 %) patients and fair outcomes in 5 (6.9 %) patients. None had a poor outcome.
  
  
  
  Our experience confirms that laparoscopic-assisted anorectal pull-through enabled complete correction of ARM in the meanwhile avoiding damage to the rectum and anus. Also, the technique of double bipolar myostimulation of muscle complex in laparoscopic ARM might lead to these better results.
authors.affiliation: Department of Pediatric Surgery, Stavropol State Medical University, Stavropol, Russian Federation. sminaev@yandex.ru.
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Minaev
authors.affiliation: Department of Pediatric Surgery, Central Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russian Federation.
authors.forename: Igor V
authors.initials: IV
authors.lastname: Kirgizov
authors.affiliation: Department of Pediatric Surgery, Regional Children Hospital, Dnepropetrovsk, Ukraine.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Gladkyy
authors.affiliation: Department of Pediatric Surgery, Central Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russian Federation.
authors.forename: Ilya
authors.initials: I
authors.lastname: Shishkin
authors.affiliation: Department of Pediatric Surgery, Stavropol State Medical University, Stavropol, Russian Federation.
authors.forename: Igor
authors.initials: I
authors.lastname: Gerasimenko
mesh_terms: D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D000071056:Anorectal Malformations / Q000601:surgery*; D016063:Blood Loss, Surgical; D003248:Constipation / Q000209:etiology; D061887:Conversion to Open Surgery; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D061646:Operative Time; D012005:Rectal Prolapse / Q000209:etiology; D012018:Reflex; D016896:Treatment Outcome