Aim of the Study: The purpose of this study is to compare the long term outcomes between laparoscopic-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) for male children with high-type anorectal malformation (ARM).
Methods: Forty-three ARM children operated between January 2005 and January 2014 were reviewed. Twenty children underwent LAARP. The outcomes were compared with those of 23 ARM children who underwent PSARP during the same period of time. Age at operation, type of fistula, associated anomalies, complications and degree of continence were evaluated. Bowel functions were assessed using the Cleveland Clinic Incontinence Score. Ethical procedures including obtaining informed consent were conducted in accordance with the ethical standards of the Committee on Human Experimentation of Cairo University.
Main Results: The mean follow up period was comparable between the two groups (6.4±2 years for LAARP vs 5.3±2.1 years for PSARP) (p=0.1). The types of fistulae were mainly recto-bulbar and recto-prostatic (43.5% and 39.3% respectively) for PSARP group (p=0.001 and 0.03 respectively), while recto-bladder neck and recto-vesical (40% and 50% respectively) for LAARP group (p=0.001 for each). Sacral anomalies in the form of absent last two sacral pieces (30% vs 4.3%) (p=0.03) and rectal prolapse (40% vs 8.7%) (p=0.02) were significantly more common in LAARP patients. The rates of normal continence (score 0:4) (p=0.3), mild incontinence (p=0.8), moderate (p=0.3) and severe incontinences (p=0.4) were similar in both groups. More patients from PSARP group developed grade 1 or 2 constipation, nevertheless without statistical significance (p=0.2 and 0.1 respectively).
Conclusion: The long term functional outcomes after LAARP and PSARP were equivalent. However, LAARP may offer better results in higher type fistulae.