Single-incision laparoscopic-assisted anorectoplasty using conventional instruments for children with anorectal malformations and rectourethral or rectovesical fistula

Abstract Background This study aims to evaluate the safety and efficacy of single-incision laparoscopic-assisted anorectoplasty (SILAARP) for children with anorectal malformations (ARM) and rectourethral or rectovesical fistula. Methods Children with ARMs and rectourethral or rectovesical fistula who underwent SILAARP between May 2011 and December 2012 were reviewed. The operative time, early postoperative and follow-up results were analyzed. Results Thirty-one patients (ARM with rectovesical vs. rectoprostatic fistula vs. rectobulbar fistula: 9/6/16) successfully underwent SILAARPs without conversions. Mean ages at operation were similar in 2 groups (ARM with rectovesical or rectoprostatic fistula vs. ARM with rectobulbar fistula: 4.94months vs . 5.67months, p=0.46). Average operative time in ARM children with rectobulbar fistula was 1.94hours, which did not differ from 1.78hours in ARM children with rectovestical or rectoprostatic fistula (p=0.39). All patients resumed feeding on postoperative day 1. The median follow-up period was 20months. No injuries of vessels, urethral or vas deferens occurred in operations. No mortality or morbidities of wound infection, rectal retraction, recurrent fistula, urethral diverticulum, anal stenosis, or rectal prolapse was encountered. Conclusions SILAARP is safe, feasible and effective for ARM with rectourethral or rectovesical fistula. One-stage SILAARP may offer a viable alternative treatment for ARM children with rectourethral or rectovesical fistula.