Laparoscopic muscle electrostimulation during laparoscopy-assisted anorectal pull-through for high imperforate anus

Yamataka, Atsuyuki; Segawa, Osamu; Yoshida, Ryuji; Kobayashi, Hiroyuki; Kameoka, Shingo; Miyano, Takeshi

doi:10.1053/jpsu.2001.27944

“…Yamataka et al used the Postoperative MRI in three patients with high imperforate anus repaired by LAARP and confirmed that the rectum was located in the center of the levator ani muscle sling and muscle complex (18) .…”

Section: Discussionmentioning

confidence: 93%

Laparoscopic Assisted Anorectoplasty: A New Definitive Repair of High Imperforate Anus

Gobran

¹

,

Saleh

²

,

Elekiabi

³

2014

Zagazig University Medical Journal

0

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Background/ Purpose : The classic treatment of the the high anorectal anomalies over the last 3 decade is the posterior sagittal anorectoplasty. . Laparoscopic assisted anorectoplasty is a minimally invasive technique that aims at preserving the sphincters, placing sensate skin within the control of the sphincters, and shortening recovery. The objective of this work is to evaluate the effectiveness of the laproscopic assisted anorectoplasty for the infants suffering from high imperforate anus. Materials & Methods: Twenty eight patients with high anorectal anomalies were included in this study. All patients had laparoscopically assisted anorectal pull-through (LAARP) for high imperforate anus. Hospital charts and surgical notes were reviewed and clinical characteristics tabulated. Results: Postoperative complications included rectal mucosal prolapsed (n=3), intestinal obstruction (n=1),anal stricture(n=1) ,and development of blind ended posterior urethral fistula(n=1 ). There were no complications related to the urinary system, also there was no wound infection, no hernia through the port sites, or anal retraction. Six cases developed constipation. The overall clinical assessment for continence of the cases showed that 50% had good outcome, 36% had moderate, and 14% had poor functional outcome Conclusion: LAARP for treatment of high anorectal anomalies is a feasible technique with encouraging functional results . Before recommendation of its use as a treatment of choice ,we recommend more studies for further evaluation of this technique, as the studies done for this subject are still few.

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“…The evaluation of the position of the rectum after pull-through is best done by MRI. Yamataka et al used the Postoperative MRI in three patients with high imperforate anus repaired by LAARP and confirmed that the rectum was located in the center of the levator ani muscle sling and muscle complex (18) . Wong et al performed post operative MRI for ten patients after LAARP and when compared with conventional PSARP patients, a significantly lower proportion of LAARP patients had sphincter asymmetry (40% vs. 100%, p<0.05) and peri-rectal fibrosis (40% vs. 87.5%, p<0.05).…”

Section: Discussionmentioning

confidence: 93%

Laparoscopic Assisted Anorectoplasty: A New Definitive Repair of High Imperforate Anus

Gobran

¹

,

Saleh

²

,

Elekiabi

³

2014

Zagazig University Medical Journal

0

View full text Add to dashboard Cite

Background/ Purpose : The classic treatment of the the high anorectal anomalies over the last 3 decade is the posterior sagittal anorectoplasty. . Laparoscopic assisted anorectoplasty is a minimally invasive technique that aims at preserving the sphincters, placing sensate skin within the control of the sphincters, and shortening recovery. The objective of this work is to evaluate the effectiveness of the laproscopic assisted anorectoplasty for the infants suffering from high imperforate anus. Materials & Methods: Twenty eight patients with high anorectal anomalies were included in this study. All patients had laparoscopically assisted anorectal pull-through (LAARP) for high imperforate anus. Hospital charts and surgical notes were reviewed and clinical characteristics tabulated. Results: Postoperative complications included rectal mucosal prolapsed (n=3), intestinal obstruction (n=1),anal stricture(n=1) ,and development of blind ended posterior urethral fistula(n=1 ). There were no complications related to the urinary system, also there was no wound infection, no hernia through the port sites, or anal retraction. Six cases developed constipation. The overall clinical assessment for continence of the cases showed that 50% had good outcome, 36% had moderate, and 14% had poor functional outcome Conclusion: LAARP for treatment of high anorectal anomalies is a feasible technique with encouraging functional results . Before recommendation of its use as a treatment of choice ,we recommend more studies for further evaluation of this technique, as the studies done for this subject are still few.

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“…There is no need to divide the muscle complex from below because the pubococcygeus can be visualized and center of the two bellies is easily targeted from above [10] with the help of laparoscope and laparoscopic muscle stimulator. Immediately after the procedure, strong and symmetric contraction of the sphincter around the neo-anus provides reassurance that the bowel has accurately been brought down through the sphincters.…”

Section: Discussionmentioning

confidence: 99%

“…In his review, the oldest patient presented at age of 68 years. Maximum number of these patients had rectovaginal fistula [10] as ARM. Surgery was performed in 19 patients and good functional results were attained in 11 patients.…”

Section: Discussionmentioning

confidence: 99%

Anorectal Anomalies in Adults-Laparoscopic Management and Review of Literature

Miglani

¹

,

Murthy

²

,

Bhat

³

et al. 2012

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Anorectal malformations (ARMs) are one of the most common congenital anomalies dealt by surgeons. The reported incidence of ARMs range between 1:3,300 and 1:5,000 live births. These defects are invariably detected and treated in infancy or early childhood. There is a group of patients among these who have fistulous external opening from the rectum. These may not present in child hood and may continue to live with fecal incontinence till adult hood. One of such anomalies is rectovaginal fistulas which comprises of only 4% of all anomalies. Delayed management in such cases increases surgical and functional complications. Traditionally high and intermediate anorectal anomalies are treated by posterior sagittal anorectoplasty (PSARP). This involves cutting of sphincter muscles in the midline and then placement of rectum in the sphincter complex. The continence results of this operation are less than ideal. Laparoscopically assisted anorectal pull-through (LAARP) has potential advantage of precise placement of the rectum inside the sphincter complex without dividing and weakening the muscles, diminished soft tissue scarring around the rectum leading to improved rectal compliance. Three adult female patients with ARMs were managed through LAARP procedure. It involves dissection around rectum, identification and ligation of fistula tract, creation of neoanus and pull through of rectum into neoanus. Results-Continence was good in all our patients which they regained after 3 to 4 days of surgery. On follow up which ranged from 6 months to 2 years all were passing well formed stools 1-2 times a day and have symmetric anal contraction with strong squeeze on digital rectal examination. Conclusion-LAARP offers an excellent option to the patients of ARM over conventional posterior sagittal anorectal approach because if its theoretical advantages of early recovery and better continence. Long term followup is needed to substantiate these results.

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Laparoscopic muscle electrostimulation during laparoscopy-assisted anorectal pull-through for high imperforate anus

Cited by 48 publications

References 1 publication

Laparoscopic Assisted Anorectoplasty: A New Definitive Repair of High Imperforate Anus

Laparoscopic Assisted Anorectoplasty: A New Definitive Repair of High Imperforate Anus

Laparoscopic Assisted Anorectoplasty: A New Definitive Repair of High Imperforate Anus

Anorectal Anomalies in Adults-Laparoscopic Management and Review of Literature

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