A comparative study between the outcomes of laparoscopy assisted and posterior sagittal anorectoplasty in the treatment of congenital anorectal malformations

doi:10.3877/cma.j.issn.2095-3224.2019.02.009

Abstract

Abstract:

Objective

The purpose of this research is to compare the outcomes of laparoscopic assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) in the treatment of congenital anorectal malformations (ARM) in male patients with rectourethral fistula (RRF).

Methods

We retrospectively analyzed of 51 cases of ARM with RRF in male patients admitted from January 2012 to December 2015 in the department of Pediatric Surgery, Shenzhen Children′s Hospital. Among them, 21 cases were treated by LAARP and 30 cases were treated by PSARP. There were 13 cases with rectovesical fistula (RVF) (LAARP 6 vs. PSARP 7), 25 cases with rectoprostatic fistula (RPF) (LAARP 10 vs PSARP 15), and 13 cases with rectobulbar fistula (RBF) (LAARP 5 vs. PSARP 8). The operating time, intraoperative bleeding, postoperative hospital stay, postoperative complications, bowel functions evaluation were compared between the two groups in the stage of anorectoplasty.

Results

There were no significant difference in follow-up period, disease type distribution, sacrum ratio and bowel function evaluation between the two groups. There were significant differences in intraoperative bleeding (14.77±6.02 vs 20.33±5.56 ml), postoperative hospital stay (10.24±2.21 vs. 14.13±2.43 days), incidence of postoperative mucosal prolapse (33.3% vs. 6.67%), operating time of RVF (2.37±0.35 vs. 2.76±0.26 h), RPF (2.10±0.26 vs. 2.53±0.31 h), RBF (3.30±0.46 vs. 2.34±0.39 h) between the LAARP and PSARP groups (P<0.05).

Conclusions

Although the incidence of postoperative mucosal prolapse is higher and there is still controversy in the treatment of the ARM with RBF, LAARP is a less invasive and efficient procedure for the ARM, especially for that with RVF and RPF.

Key words: Children, Laparoscopes, Congenital anorectal malformation, Posterior sagittal anorectoplasty

Dechao Wu, Lei Liu. A comparative study between the outcomes of laparoscopy assisted and posterior sagittal anorectoplasty in the treatment of congenital anorectal malformations[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(02): 150-154.

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Figures/Tables 5

References 19

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组别	例数	二期手术平均年龄（月）	平均随访时间（年）	合并RVF病例［例（%）］	合并RPF病例［例（%）］	合并RBF病例［例（%）］	骶骨比率
LAARP组	21	6.48±0.98	3.75±0.70	6（28.6）	10（47.6）	5（23.8）	0.54±0.10
PSARP组	30	4.23±1.61	3.87±0.83	7（23.3）	15（50.0）	8（26.7）	0.56±0.10
t/χ²值	?	6.16	-0.54	0.18	0.03	0.05	-0.70
P值	?	<0.001^*	0.60	0.67	0.87	0.82	0.49

组别	例数	二期手术平均年龄（月）	平均随访时间（年）	合并RVF病例［例（%）］	合并RPF病例［例（%）］	合并RBF病例［例（%）］	骶骨比率
LAARP组	21	6.48±0.98	3.75±0.70	6（28.6）	10（47.6）	5（23.8）	0.54±0.10
PSARP组	30	4.23±1.61	3.87±0.83	7（23.3）	15（50.0）	8（26.7）	0.56±0.10
t/χ²值	?	6.16	-0.54	0.18	0.03	0.05	-0.70
P值	?	<0.001^*	0.60	0.67	0.87	0.82	0.49

组别	例数	手术时间（h）	术中出血量（mL）	术后住院时间（天）
LAARP组	21	2.46±0.59	14.77±6.02	10.24±2.21
PSARP组	30	2.55±0.34	20.33±5.56	14.13±2.43
t值	?	-0.64	-3.41	-5.84
P值	?	0.53	<0.001^*	<0.001^*

组别	例数	手术时间（h）	术中出血量（mL）	术后住院时间（天）
LAARP组	21	2.46±0.59	14.77±6.02	10.24±2.21
PSARP组	30	2.55±0.34	20.33±5.56	14.13±2.43
t值	?	-0.64	-3.41	-5.84
P值	?	0.53	<0.001^*	<0.001^*

组别	例数	RVF	RPF	RBF
LAARP组	21	2.37±0.35	2.10±0.26	3.30±0.46
PSARP组	30	2.76±0.26	2.53±0.31	2.34±0.39
t值	?	-4.57	-5.20	8.03
P值	?	<0.001^*	<0.001^*	<0.001^*

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