Laparoscopic-Assisted Anorectoplasty for Anorectal Malformations Without Rectourinary Fistula Ligation: Two Decades of Experience at a Tertiary Center

Abstract

Aim:

To report our experience with laparoscopic-assisted anorectoplasty (LAARP) for anorectal malformations (ARM) performed without ligation of the rectourinary fistula (RUF).

Methods:

In this single-center study, we retrospectively analyzed all consecutive primary LAARP procedures for ARM without RUF ligation performed between 2004 and 2022. Forty patients were included (19 rectobulbar, 16 rectoprostatic, 5 rectobladder). Colostomy was performed at a median age of 1 day and LAARP at 147 days (median weight 6 kg). Median operative time was 180 minutes, and 1 patient required conversion. No early complications were associated with omission of RUF ligation. Foley catheters were kept for a median of 10 days, postoperative stay was 5 days, and colostomy closure occurred at 7 months. The median follow-up was 6.7 years. Cystoscopy and cystography were performed in 17% and 20% of patients, respectively, with no remnants of the original fistula (ROOF). Eight patients (20%) had urological issues: neurogenic bladder (n = 3), bladder dyssynergia (n = 2), urinary retention (n = 2), and non-LAARP-related urethral stenosis (n = 1). Regarding late outcomes, 2 patients (5%) underwent redo anorectoplasty, 11 (27%) required prolonged dilations, 4 (10%) underwent redo anoplasty, and 2 (5%) underwent revision for mucosal prolapse. Among those >4 years, 84% had voluntary bowel movements, 76% soiling, and 52% constipation; 53% of those <4 years required laxatives.

Conclusions:

LAARP without ligation of the RUF for ARM appears to be a safe and effective technique, with favorable long-term urological and functional outcomes. No patients experienced urethral injury or ROOF.