Division of the fistula in laparoscopic-assisted repair of anorectal malformations—are clips or ties necessary?

Intraoperative measurement of rectourethral fistula: prevention of incomplete excision in male patients with high-/intermediate-type imperforate anus

“…Rollins et al [4] have reported that simple division of the RUF is safe and successful. They divided the RUF flush with the urethra without using ties; but extended urethral catheterization was required (6-40 days), and cystourethrography was needed for removal of the urethral catheter and was repeated in some cases to confirm that there was no leakage of urine into the pelvic cavity after LAARP.…”

Laparoscopy and its use in the repair of anorectal malformations

“…The diagnoses were rectoprostatic fistula (98), no diagnosis noted (75), rectobulbar fistula (36), rectovaginal fistula (26), "rectourethral" fistula (20), rectobladder neck fistula (20), cloaca (19), imperforate anus with no fistula (11), rectovestibular fistula (8), rectal atresia (5), rectoperineal fistula (4), and congenital rectal stenosis (1) ( Table 1).…”

Acquired posterior urethral diverticulum following surgery for anorectal malformations

“…The advent of laparoscopy-assisted anorectal pull-through has heightened concerns about the development of posterior urethral diverticulum especially when the technique is used to treat cases of rectobulbar fistula [2]. The laparoscopic approach has been associated with posterior urethral diverticulum despite improved visualization from above and flush ligation of the fistula [11,12]. Koga et al [13] reported a case of posterior urethral diverticulum following laparoscopy-assisted pull-through in a boy who was treated for a rectourethral bulbar fistula.…”

“…Simple division of the fistula and placement of an indwelling urethral catheter, without using clips or sutures, have been proposed to lower the risk of injuries to the urethra [12]. However, one of 5 patients who had a simple division of the rectourethral fistula in that study developed a posterior urethral diverticulum at a follow-up of 10 to 19 months [12]. In addition, the presence of clips in a posterior urethral diverticulum resulted in calcification of a pelvic mass in one of our patients.…”