Residual fistula after laparoscopically assisted anorectoplasty: is it a rare problem?

详细信息    查看全文

• 作者：Hiroo Uchida ; Tadashi Iwanaka ; Yoshihiro Kitano ; Sumi Kudou ; Tetsuya Ishimaru ; Katsumi Yotsumoto ; Chikashi Gotoh ; Mariko Yoshida
• 关键词：Laparoscopically assisted anorectoplasty (LAARP) ; Posterior urethral cystic formation ; Residual fistula ; Magnetic resonance imaging (MRI) ; Voiding cystourethrography (VCUG)
• 刊名：Journal of Pediatric Surgery
• 出版年：2009
• 出版时间：January 2009
• 年：2009
• 卷：44
• 期：1
• 页码：278-281
• 全文大小：226 K

文摘

Purpose

Although various urologic complications have been reported after abdominoperineal pull-through and posterior sagittal anorectoplasty for the treatment of high-type imperforate anus, reports regarding complications after laparoscopically assisted anorectoplasty (LAARP) are surprisingly rare. Here, we discuss the potential complications of LAARP.

Methods

A retrospective study was conducted of 24 patients treated with LAARP from 2000 to 2006. The clinical and operative records were reviewed. Of the 24 patients, 18 were evaluated postoperatively by screening magnetic resonance imaging (MRI).

Results

The 24 participants are composed of patients with rectoprostatic urethral fistula (n = 15), rectal agenesis (n = 3), rectovesical fistula (n = 2), rectovaginal fistula (n = 2), and cloaca (n = 2). Defecatory function after LAARP was satisfactory. None of the patients had dysuria or urinary infection postoperatively. Cystic formations posterior to the urethra were demonstrated in 9 of the 18 cases examined by MRI. Postoperative voiding cystourethrography failed to demonstrate the lesion in 6 of 9 patients. The types of imperforate anus in this subgroup were rectoprostatic urethral fistula (n = 7), rectovesical fistula (n = 1), and rectal agenesis without fistula (n = 1). Average cyst diameter was 22 ± 19 mm. Two patients with large cysts (62 and 42 mm) underwent surgical resection.

Conclusions

Although satisfactory fecal continence could be achieved by LAARP, we experienced 2 cases with a large residual fistula that required surgical resection. In addition, screening MRI demonstrated the presence of cystic formations in 9 of 18 patients. We recommend that MRI be performed routinely during follow-up of patients treated with LAARP.