The Role of Laparoscopy in Anorectal Malformations

Abstract

The use of laparoscopy in the minimally invasive management of anorectal malformations (ARMs) continues to evolve, although the principles guiding the anatomic surgical repair and clinical follow-up remain unchanged. In this review, we detail the advantages, indications, contraindications, complications, and issues unique to the minimally invasive approach to ARM. A comprehensive search of the PubMed and Embase databases was performed (2014–2018). Full-text screening, data abstraction, and quality appraisal were performed of articles describing the use of laparoscopy in ARM and cloaca. While new developments and approaches to ARM utilizing minimally invasive techniques and timing for surgical approach have been detailed, a unique complication profile involving greater risk of rectal prolapse and retention of a remnant of the original fistula are still consistently reported. Analysis of perioperative complications and long-term functional outcomes, including rates of fecal and urinary continence, are lacking. It is clear that patient selection for the choice of surgical approach based on precise preoperative delineation of the anatomy is the key. Adherence to the principles of ARM repair as well as application of operative/imaging adjuncts will yield the best technically safe minimally invasive approach to ARM. Continued efforts for standardized reporting and long-term follow-up are required.

Percutaneous Anorectoplasty (PARP)—An Adaptable, Minimal-Invasive Technique for Anorectal Malformation Repair

“…Despite the argument that this allows accurate visualization of anatomical structures, thus allowing the most accurate surgical correction and preservation of blood vessels and nerve structures, current studies in the literature increasingly consider that the invasiveness of this method may not be necessary in certain cases [2,10,11]. Laparoscopy can assist with repair of high forms of ARMs while leaving the sphincter intact [7,10], although the intuitive hypothesis that this could improve the functional prognosis in terms of decreasing cases of fecal incontinence and constipation has not yet been conclusively confirmed [9,10,12,13]. Nevertheless, the laparoscopic, sphincter-sparing approach indeed has been shown to significantly reduce postoperative wound complications and hospital stay [9,10,12,14].…”

Image of the Month: High Pressure Distal Colostogram in a Patient with an Anorectal Malformation

“…In these circumstances, a transabdominal approach (laparoscopy or laparotomy) might be necessary to expose and gain access to the fistula. 5 A very good trick on how to determine the level of the recto-urinary fistula has been suggested by Halleran et al (►Fig. 3).…”

“…), respectively. 5 The ultimate aim of the high pressure distal colostogram is to help the surgeon determine if the ARM should be approached via a transabdominal approach or via perineal approach only. 2 A trick for this based on the contrast study is by drawing the PC line and determining what is the first structure you will find when the surgical approach is via a posterior sagittal incision (►Fig.…”

Malformaciones anorrectales en pediatría

“…El tratamiento quirúrgico de los ARM representa una de las pocas áreas en cirugía pediátrica donde las técnicas quirúrgicas no pueden determinar el éxito de la misma hasta después de varios años. La mayoría de los infantes con esta condición se someten a procedimientos quirúrgicos antes del primer año de vida (14). De acuerdo con las distintas ARM, se extiende una gran variedad de intervenciones quirúrgicas, entre las que se describen: anoplastia (de corte, sagital posterior), anorrectoplastia sagital posterior (PSARP), dilatación anal y colostomía (15).…”