Primary laparoscopic repair of high imperforate anus in neonatal males

Laparoscopic-assisted anorectal pull-through for anorectal malformations: a systematic review and the need for standardization of outcome reporting

“…One study did not report the mean age at operation [7]. Only 2 studies reported operative time [8,9]. Geographically, most studies (13, 76.4%) were published from Asian centers, whereas North America and Europe contributed 2 each (11.8%).…”

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

“…In these 5 patients (Table 1), the location of the fistula was rectoprostatic (2) and rectobulbar (3). The perineum of the patients with a rectum-urethral prostatic fistula was flat, whereas those with a rectum-urethral bulbar fistula had a good gluteal crease.…”

“…Although there have been reports advocating primary laparoscopic repair of high imperforate anus without protective colostomy in neonatal males [3], this is not our practice. Early in our experience with LAARP, we continue to favor the traditional 3-stage approach.…”

“…In 2000, Georgeson et al [2] introduced a laparoscopically assisted technique (laparoscopic-assisted anorectoplasty [LAARP]) that has gained interest because of improved visualization of the rectal fistula and surrounding structures, proper placement of the rectum without division of the muscle complex, and minimal abdominal and perineal wounds. In Georgeson's original description of the procedure, the rectourethral fistula was divided between clips; however, other techniques such as ties [3], suture closure [4], and division using the harmonic scalpel (Ultracision, Ethicon) have been used. Complications such as urethral stricture or recurrent fistula have been reported when the fistula is divided between clips [4].…”

Minimally invasive surgery in neonates

“…Yenidoğan dönemde mesane boynuna veya prostatik üretraya açılan fistülün laparoskopi ile primer onarımı Vick ve ark. (30) tarafından tanımlandı. Fakat yenidoğan döneminde yüksek tipli atrezide öncelikle kolostomi yapılması ve ardından definitif ameliyatın planlanması genellikle kabul edilen tedavi şeklidir.…”