Postoperative “complications" following laparoscopic-assisted anorectoplasty: A systematic review

Abstract

Aim This study reviewed the literature on the postoperative complications following laparoscopic-assisted anorectoplasty (LAARP). Methods A Medline and Embase search was performed for the terms "anorectal malformation" (ARM) "laparoscopic" and "complication". Articles without English full text, review articles, systematic reviews, case reports, case series < 5 cases and duplicate articles were excluded. Two reviewers independently performed the eligibility assessment and data extraction. Data were collected for type of malformation, surgical technique, postoperative complications and functional outcomes Results The search retrieved 108 articles, of which 38 met the inclusion criteria and offered 1058 patients for analysis. Rectoprostatic and rectobladder neck fistula were the most common types of ARM in males, whereas it was the common cloaca in females. Analysis of complications demonstrated rectal prolapse (n = 149; 14.08%) being the most prominent, followed by urethral diverticulum (n = 32; 3.02%), anal stenosis (n = 37; 3.49%), recurrent fistula (n = 7; 0.66%) and rectal stricture (n = 4; 0.37%). Krickenbeck classification was used for functional assessment in 638 patients, with fecal soiling grade 2 or > 2 in 79. Data on functional outcome specific to the type of malformation was available for 246 patients: fecal soiling grade 2 or > 2 in 15/94 (15.95%) with rectoprostatic fistula, 26/73 (35.61%) with rectobladder neck fistula, 6/47 (12.76%) with common cloaca, and 1/22 (4.54%) with no fistula. Conclusion Rectal prolapse, posterior urethral diverticulum and anal stenosis are the most common complications after LAARP. Inconsistent and non-uniform functional assessment and non-availability of information about the sacrum and spine make it difficult to analyze the functional outcome following LAARP.

Laparoscopic-assisted anorectoplasty for anorectal malformation with rectobulbar fistula: A two-center comparative study with posterior sagittal anorectoplasty

“…Firstly, the deep location of the rectal pouch and long common wall of the fistular and rectum increases the difficulty of transabdominal/laparoscopic dissection, leading to a high risk of urethral diverticulum. [22] The incidence of posterior urethral diverticulum appeared to be rare in recent years as distal colostogram was all carried out before repair and surgeons became proficient in PSARP. However, Peña et al reported that 20 cases of RBF developed urethral diverticulum, all of which had previously undergone the transabdominal approach.…”

“…[22,23] Finally, the value of LAARP on bowel function has been questioned, owing to the short follow-up and subjective parameters of the scores. [22]…”

“…The latest results regarding the long-term outcomes of ARM with RBF from Koga et al reported that the incidence of rectal prolapse was 32% (8/25), which was significantly greater than in the PSARP group. [22,23] Finally, the value of LAARP on bowel function has been questioned, owing to the short follow-up and subjective parameters of the scores. [22] In our study, we found no significant differences in operative time or postoperative complications between the LAARP and PSARP groups.…”

Laparoscopic-Assisted Modified Posterior Sagittal Anorectoplasty for Rectobulbar Urethral Fistula of Anorectal Malformation: A Prospective Study

“…[ 10 ] The LAARP for RPUF is known to have rectal prolapse in 14.08% and a posterior UD in 3.02% of patients. [ 14 ] The higher propensity of the UD is peculiar to RBUF, unlike RPUF where fistula management is relatively easier with a laparoscopic approach and has proved to be safe. [ 15 ] MRI is more sensitive than cystoscopy and voiding cystourethrogram (VCUG) to detect UD as the urethral side of the fistula gets sealed, and the UD does not communicate with the urethra.…”

Where Is the Vagina? A Rectal Stricture after a Presumed Cloacal Repair Turns Out to be the Mobilized Vagina and a Missed High Rectovaginal Fistula

“…Common postoperative complications of ARM repair include rectal prolapse, remnant of the original fistula, anal or rectal stricture, wound dehiscence, and recurrent fistula. 1 A cloacal malformation is characterized by a single perineal orifice in which the urologic, gynecologic, and gastrointestinal tracts meet. It represents one of the most complex congenital anomalies of the pelvic organs in females, with an incidence of 1 in 50,000 births.…”