Application of anchoring stitch prevents rectal prolapse in laparoscopic assisted anorectal pullthrough.
BACKGROUND
Rectal prolapse has been reported after laparoscopic assisted anorectal pullthrough in children with anorectal malformation. We report our clinical outcome and study the application of an anchoring stitch to tack the rectum to the presacral fascia and the occurrence of rectal prolapse.


METHODS
A retrospective review of all children who had undergone laparoscopic assisted anorectal pullthrough for anorectal malformation from 2000 to 2015 was performed. Patients were divided into two groups (group I: with anchoring stitch, group II: without anchoring stitch). Outcome measures including rectal prolapse, soiling, voluntary bowel control, and constipation, and Kelly Score were analyzed.


RESULTS
There were thirty-four patients (group I, n=20; group II, n=14) undergoing laparoscopic assisted anorectal pullthrough during the study period. The median follow up duration for group I and group II was 60months and 168months, respectively. All patients had stoma performed prior to the operation. Both groups consisted of patients with high type (30% vs 57%, p=0.12) and intermediate type (70% vs 43%, p=0.12) anorectal malformation. Seven (35%) patients in group I and 3 (21%) in group II had concomitant vertebral and spinal cord pathologies (p=0.408). The mean operative time was significantly shorter in group I (193±63min vs 242±49min, p=0.048). Rectal prolapse occurred less in group I, 4 (20%) vs 9 (64%) patients in group II and was statistically significant (p=0.008). Median time to development of rectal prolapse was 7months in group I and 5months in group II (p=0.767). Mucosectomy was performed in 15% of group I and 36% of group II (p=0.171). Soiling occurred less in group I (55% vs 79%, p=0.167). Voluntary bowel control (85% vs 93%, p=0.499) and constipation (55% vs 64%, p=0.601) were comparable in both groups. 75% in group I and 71% in group II achieved a Kelly score of 5 or above (p=0.823).


CONCLUSIONS
Our study showed application of anchoring stitch reduces rectal prolapse and soiling in laparoscopic assisted anorectal pullthrough. Treatment Study-Level III.
Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Jessie L
JL
Leung
Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Patrick H Y
PH
Chung
Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Paul K H
PK
Tam
Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong. Electronic address: kkywong@hku.hk.
Kenneth K Y
KK
Wong
D001003:Anal Canal / Q000601:surgery*; D000071056:Anorectal Malformations / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012005:Rectal Prolapse / Q000209:etiology / Q000517:prevention & control*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome
Anorectal malformation; Continence; Laparoscopic assisted anorectal pull-through; Rectal prolapse; Rectourinary fistula; Soiling