29 EXPERIENCE WITH LAPAROSCOPIC-ASSISTED ANORECTAL PULL-THROUGH IN 22 MALE ANORECTAL MALFORMATIONS WITH RECTO-URETHRAL BULBAR FISTULA: IS IT INDICATED OR NOT?
Yerang Jang, Jeong-Mean Seo, Sanghoon Lee, Suk-Koo Lee
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of

Abstract

Aim) LAARP (laparoscopic-assisted anorectal pull-through) has been controversy about indication for recto-urethra bulbar fistula of male anorectal malformation (ARM). The aim of this study was to show technical availability and safety of LAARP for ARM and recto-urethral bulbar fistula.

Method) Between 2003 and 2017, we performed 91 LAARP for male ARM including 23 recto-bulbar urethral fistula. We retrospectively analyzed the clinical outcomes in 22 male patients with recto-bulbar urethral fistula (1 patient was excluded due to follow-up loss).

Main results) Mean age of the patients at the time of LAARP was 3.4 ±1.5 months and colostomy repair was done simultaneously. There was no immediate postoperative complication. However, by long term follow-up, rectal prolapses occurred in 13 patients after 11 months (median duration) from LAARP. Twelve of them underwent excision for the prolapse six months (median duration) after recognizing the prolapse. Seven of eight patients over five years old obtained voluntary bowel movement and good functional results, the remaining one patient showed soiling at day time. Five patients aged three to four were in the process of toilet training. All of them had fecal sensations. Nine patients under the age of two did not report soiling or dyspareunia without the help of enema or laxatives. In order to prevent prolapse, we modified the surgical technique from the second half of 2016. Since then, no prolapse has happened until recently.

Conclusion) Although, there is a problem of causing prolapses, it is thought to be overcome by modifying the surgical techniques, and still under the ideal concept of “not cutting the sphincter muscle complex”, LAARP might be acceptable and safe procedure for the patients with ARM with recto-urethral bulbar fistula.

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