Post-operative magnetic resonance evaluation of children after laparoscopic anorectoplasty for imperforate anus

Wong, Ka-Chun; Khong, Pek‐Lan; Lin, Scl; Lam, Wendy Wai Man; Lan, Lawrence C L; Tam, Paul Kwong‐Hang

doi:10.1007/s00384-004-0620-6

Cited by 51 publications

(52 citation statements)

References 15 publications

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“…In respect of this, there may be a role for laparoscopic assisted pull through reconstruction of high ARA through a minimal perineal dissection because it avoids division of anal sphincter muscle complex [50]. Laparoscopic approach preserves the distal rectum and IAS, which is placed accurately within the sphincter complex, and it reduces the risk of pelvic nerve injury through superior visualisation [50,51]. However, the long-term results for faecal continence are not available at present.…”

Section: Discussionmentioning

confidence: 96%

Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography

et al. 2008

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The aim of this study was to evaluate role of anorectal manometry (ARM) and anal endosonography (ES) in assessment of the internal anal sphincter (IAS) quality on continence outcome following repair of anorectal anomalies (ARA). We devised a scoring system to evaluate the quality of the IAS based on ARM and ES and correlated the scores with clinical outcome, using a modified Wingfield score (MWS) for faecal continence. We also assessed the implication of megarectum and neuropathy on faecal continence. Of 54 children studied, 34 had high ARA and 20 had low ARA. Children with high ARA had poor sphincters on ES and ARM, and also poor faecal continence compared to those with low ARA. The presence of megarectum and neuropathy was associated with uniformly poor outcome irrespective of the IAS quality. The correlations between MWS on one hand, and ES and ARM scores for IAS on the other hand were weak in the whole study group, ES r = 0.27, P < 0.04, and ARM r = 0.39, P < 0.004. However, the correlations were strong in those who had isolated ARA without megarectum or neuropathy, ES r = 0.51, P < 0.02 and ARM r = 0.55, P < 0.01, respectively. In conclusion, the ARM and ES are valuable in evaluation of continence outcome in children after surgery for ARA and those with good quality IAS had better faecal continence. The IAS is a vital component in functional outcome in absence of neuropathy and megarectum.

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Section: Discussionmentioning

confidence: 96%

Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography

et al. 2008

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“…Specifically, frequency of motions, staining/soiling, and incidence of erosions were better in GLA subjects, and the difference between GLA and PPA for staining/soiling was statistically significant 4 years after surgery. However, in the literature, there are only 2 reports comparing midterm outcome of GLA and PPA [1,2]. Kudou et al [1] found that both GLA and PPA patients had similar bowel habits.…”

Section: Discussionmentioning

confidence: 96%

“…In recent reports [1][2][3] about short-to midterm outcome after Georgeson's laparoscopy-assisted anorectoplasty (GLA) for high/intermediate-type imperforate anus (HIIA) [4], GLA appeared to be as good as or even better than Pena's posterior sagittal anorectoplasty (PPA). However, there are no prospective studies comparing GLA and PPA in the literature, and past reports about continence evaluation have usually been retrospective.…”

mentioning

confidence: 95%

Midterm postoperative clinicoradiologic analysis of surgery for high/intermediate-type imperforate anus: prospective comparative study between laparoscopy-assisted and posterior sagittal anorectoplasty

Ichijo

Kaneyama

Hayashi

et al. 2008

Journal of Pediatric Surgery

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“…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). The positioning of the rectum was, however, central for both groups (90% vs. 87.5%) (19) . In this study post-operative MRI was done for all cases.…”

Section: Discussionmentioning

confidence: 85%

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

Gobran

Saleh

Elekiabi

2014

Zagazig University Medical Journal

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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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Post-operative magnetic resonance evaluation of children after laparoscopic anorectoplasty for imperforate anus

Abstract: LAR allows more optimal anatomical reconstruction for patients with the high/intermediate types of imperforate anus. However, additional factors that are not correctable by surgery, such as intrinsic innervation deficiency, also influence the clinical outcome.

Cited by 51 publications

References 15 publications

Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography

Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography

Midterm postoperative clinicoradiologic analysis of surgery for high/intermediate-type imperforate anus: prospective comparative study between laparoscopy-assisted and posterior sagittal anorectoplasty

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

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