title: Magnetic resonance imaging (MRI)-assisted laparoscopic anorectoplasty for imperforate anus: a single center experience.
abstract: OBJECTIVE
  Surgical procedures for high imperforate anus have ranged from the posterior sagittal anorectoplasty (PSARP) to laparoscopic-assisted anorectoplasty (LAARP). PSARP bisects the sphincter muscle complex, introducing muscle injury and scarring. LAARP uses a straight trocar to traverse an often non-linear sphincter muscle complex. MRI-assisted LAARP (MRI-LAARP) guides the neorectum precisely through the middle of the entire sphincter complex along its trajectory. We present our experience utilizing MRI intraoperatively during LAARP.
  
  
  METHODS
  Ten children underwent MRI-LAARP procedures. Intraoperative MRI was performed to delineate the sphincter complex, and to guide the advancement of an MRI-compatible needle through the center of the complex from skin to the peritoneal cavity. The remainder of the procedure was completed using the standard LAARP technique.
  
  
  RESULTS
  All had successful MRI needle placement through the sphincter complex. Nine patients had successful laparoscopic pull-through procedures; one was converted to open due to severe intraperitoneal adhesions. Postoperative stay averaged 5.4 ± 4.4 days. Out of the ten patients, one child had mild dehiscence of the anal anastomosis requiring revision 11 days postoperatively.
  
  
  CONCLUSIONS
  The theoretical advantage of the MRI-LAARP is placing the neorectum through the entire sphincter complex without transecting the muscle. Follow-up of these patients shows good short-term results; however, long-term follow-up will be needed to best assess sphincter and bowel function.
authors.affiliation: Department of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan Health Care System, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI, 48109-4211, USA.
authors.forename: Tina T
authors.initials: TT
authors.lastname: Thomas
authors.affiliation: Department of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan Health Care System, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI, 48109-4211, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
authors.affiliation: Department of Radiology and Interventional Radiology, C. S. Mott Children's Hospital, University of Michigan Health Care System, Ann Arbor, MI, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Smith
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Dillman
authors.affiliation: Department of Radiology and Interventional Radiology, Children's National Health System, NW Washington DC, USA.
authors.forename: Ranjith
authors.initials: R
authors.lastname: Vellody
authors.affiliation: Department of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan Health Care System, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI, 48109-4211, USA. marjarbo@med.umich.edu.|Department of Radiology and Interventional Radiology, C. S. Mott Children's Hospital, University of Michigan Health Care System, Ann Arbor, MI, USA. marjarbo@med.umich.edu.
authors.forename: Marcus D
authors.identifier: http://orcid.org/0000-0002-0884-0050
authors.initials: MD
authors.lastname: Jarboe
mesh_terms: D001003:Anal Canal / Q000000981:diagnostic imaging / Q000601:surgery*; D001006:Anus, Imperforate / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010529:Peritoneal Cavity; D019651:Plastic Surgery Procedures / Q000379:methods*; D012007:Rectum / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Anorectal malformation; Imperforate anus; MRI-LAARP (laparoscopic-assisted anorectoplasty); MRI-assisted anal pull through