Laparoscope-Assisted Anorectal Pull-Through for High-Imperforate Anus in a Female

Abstract

Introduction:

This video describes the effective use of laparoscope-assisted anorectal pull (LAAP)-through in a 3-month-old female, status post-diverting colostomy on day 2 of life, with a high-imperforate anus seen on a distal stomagram.

Materials and Methods:

LAAP was performed with a 4-mm infraumbilical camera port and two 3-mm working ports in the right and left lower quadrants. The procedure was started by opening the peritoneal reflection, and dissecting out the distal rectal pouch using blunt dissection and a bipolar energy device. The dissection was continued distally directly on the rectum until the rectum was seen attaching to the lower half of the vagina, indicating a likely rectovaginal fistula that was not seen on her stomagram. A 5-mm stapler was used to separate the distal rectum from the vagina directly on the vaginal wall, so as to avoid creating a diverticulum. The middle of the sphincter complex was identified using a transcutaneous electrostimulator, and a 1 cm perineal incision was created over this. A Veress needle was placed through the middle of the sphincter complex into the abdomen under laparoscopic observation, and dilated up to a 10-mm trocar. A clamp was placed through the 10-mm trocar to pull the rectum into the anus in the middle of the sphincter complex. The anocutaneous anastomosis was then created. The procedure was completed by placing hitch stitches between the rectum and the sacrum bilaterally to prevent future rectal prolapse.

Results:

The patient tolerated the procedure well and was started on anal dilations at 1 month postoperatively and underwent a colostomy takedown at 6 weeks postoperatively.

Conclusion:

LAAP can effectively be used in a female with a high-imperforate anus. The advantages of LAAP are it allows for minimal perineal dissection, it preserves the distal rectum, and allows for accurate placement of the rectum in the middle of the sphincter complex. ¹

SR: Ownership in JustRight Surgical; SA: no competing financial interests exist.

Runtime of video: 4 mins 49 secs