Combined laparoscopic and modified posterior sagittal approach saving the external sphincter for rectourethral fistula: An easier and more physiologic approach

Liêm, Nguyễn Thanh; Tran, Quynh Anh

doi:10.1016/j.jpedsurg.2013.03.007

Cited by 15 publications

(16 citation statements)

References 22 publications

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“…we did not include cases with sacral regression) and using the SSARP approach, which provides minimal dissection and leaves the sphincter untouched. Laparoscopically‐assisted anorectal pull through (LAARP) has been popularized – not only to assess and target the pubococcygeus from above, but also to avoid dividing the muscle complex from below and minimize the amount of posterior dissection required to accurately place the rectum within the muscle complex . Besides its cost and technical demand procedure, the passage of laparoscopy trocars through the perineum has the potential of injuring the urinary system.…”

Section: Discussionmentioning

confidence: 86%

“…Laparoscopically-assisted anorectal pull through (LAARP) has been popularized -not only to assess and target the pubococcygeus from above, but also to avoid dividing the muscle complex from below and minimize the amount of posterior dissection required to accurately place the rectum within the muscle complex. [17][18][19] Besides its cost and technical demand procedure, the passage of laparoscopy trocars through the perineum has the potential of injuring the urinary system. Pulling through the rectum without securing it to the muscle could also increase the incidence of postoperative rectal prolapse.…”

Section: Discussionmentioning

confidence: 99%

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Sphincter‐saving anorectoplasty for correction of anorectal malformations

Eltayeb

Shehata

2015

Surgical Practice

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Aim: Posterior sagittal anorectoplasty (PSARP) popularized by de Vries and Peña has become the preferred technique for surgical correction of anorectal malformations (ARM). Despite performing a technically perfect operation, it involves midline division of the sphincter with a subset of patients requiring significant lifelong bowel management for constipation or incontinence. Pratap et al. introduced sphincter-saving anorectoplasty (SSARP) trying to spare the sphincter. The aim of this study is to preserve the neurophysiological function of the sphincter through SSARP in ARM patients and evaluate the outcome of these patients through this approach. Patients and Methods: This prospective study conducted on ARM cases presented with high or intermediate anomalies. Patients with sacral agenesis and rectovesical fistula were excluded from the study. All patients underwent pre and postoperative electrophysiological studies of the external anal sphincter. Also a guide wire was introduced through the middle of the sphincter under sonographic guidance in all patients immediately before the operation. Results: During the study period from January 2011 to September 2014 18 cases underwent surgical correction with SSARP technique. Their age ranged from 6 months to 5 years and weight ranged from 7 kg to 20 kg. The total duration of the SSARP procedure ranged from 65 to 90 min. There were no intra-operative complications or mortality. No conversion to classic PSARP approach was necessary in any case. During the follow-up period no recurrent urethral fistula or urinary retention was observed. Conclusion: SSARP technique is a safe and effective approach in correction of ARM with acceptable postoperative complications.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Sphincter‐saving anorectoplasty for correction of anorectal malformations

Eltayeb

Shehata

2015

Surgical Practice

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“…Feasibility and safety of the LAARP approach has been demonstrated for high/intermediate type ARMs [27, 30]. To some extent, LAARP has many advantages, including minimal surgical trauma, excellent visualization of rectal fistula and gynecologic anatomy, potentially fewer wound complications, and accurate placement of the bowel into levator ani and the sphincteric complex [11, 30, 31]. Furthermore, Wong et al [25] considered that it was more accurate and required fewer other variables to compare LAARP with PSARP using high/intermediate anorectal malformations in studies.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopically Assisted Anorectal Pull-Through versus Posterior Sagittal Anorectoplasty for High and Intermediate Anorectal Malformations: A Systematic Review and Meta-Analysis

et al. 2017

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ObjectiveAnorectal malformations (ARMs) are one of the commonest anomalies in neonates. Both laparoscopically assisted anorectal pull-through (LAARP) and posterior sagittal anorectoplasty (PSARP) can be used for the treatment of ARMs. The aim of this systematic review and meta-analysis is to compare these two approaches in terms of intraoperative and postoperative outcomes.MethodsMEDLINE, Embase, Web of Science and the Cochrane Library were searched from 2000 to August 2016. Both randomized and non-randomized studies, assessing LAARP and PSARP in pediatric patients with high/intermediate ARMs, were included. The primary outcome measures were operative time, length of hospital stay and total postoperative complications. The second outcome measures were rectal prolapse, anal stenosis, wound infection/dehiscence, anorectal manometry, Kelly's clinical score, and Krickenbeck classification. The quality of the randomized and non-randomized studies was assessed using the Cochrane Collaboration's Risk of Bias tool and Newcastle-Ottawa scale (NOS) respectively. The quality of evidence was assessed by GRADEpro.ResultsFrom 332 retrieved articles, 1, 1, and 8 of randomized control, prospective and retrospective studies, respectively, met the inclusion criteria. The randomized clinical trial was judged to be of low risk of bias, and the nine cohort studies were of moderate to high quality. 191 and 169 pediatric participants had undergone LAARP and PSARP, respectively. Shorter hospital stays, less wound infection/dehiscence, higher anal canal resting pressure, and a lower incidence of grade 2 or 3 constipation were obtained after LAARP compared with PSARP group values. Besides, the LAARP group had marginally less total postoperative complications. However, the result of operative time was inconclusive; meanwhile, there was no significant difference in rectal prolapse, anal stenosis, anorectal manometry, Kelly's clinical score and Krickenbeck classification.ConclusionFor pediatric patients with high/intermediate anorectal malformations, LAARP is a better option compared with PSARP. However, the quality of evidence was very low to moderate.

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“…LAARP has some advantages including avoiding laparotomy, minimal surgical trauma, excellent visualization of the rectal fistula and gynecologic anatomy, potentially fewer wound complication and accurate placement of the bowel into the levator ani and sphincteric complex [9,10]. There were a few reports in the literature describing the laparoscopy approach for management of cloacal malformation [11][12][13].…”

Section: Discussionmentioning

confidence: 99%