PAPS PaperApplication of anchoring stitch prevents rectal prolapse in laparoscopic assisted anorectal pullthrough☆
Section snippets
Material and methods
Retrospective review of all children who had undergone laparoscopic assisted anorectal pullthrough for high-/intermediate-type anorectal malformation from 2000 to 2015 was performed. We divided the patients into two groups (group I: with anchoring stitch, group II: without anchoring stitch). To facilitate dissection of the rectum to a precise length that was just enough to be brought down to the anus without redundancy, we evacuated meconium from the sigmoid colon and rectum when the initial
Results
Thirty-seven patients had undergone LAARP during our study period. Three patients were lost to follow up immediately after LAARP and were excluded. There was a total of thirty-four patients (group I, n = 20; group II, n = 14) included in our study. The demographics of our patients were summarized in Table 1. The median follow up duration for group I and group II was 60 months and 168 months respectively. All patients had colostomy performed prior to the operation. Both groups consisted of patients
Discussion
LAARP has been practiced in our center since its publication by Georgeson in 2000 [1]. This technique allowed a precise placement of the rectum inside the sphincter complex without dividing and weakening the muscles, a superior exposure of the rectal fistulae and the surrounding pelvic structures [1], [6], [7], [8], [16], [17], [18]. Our center had previously reported an improvement in rectal resting pressure and rectoanal inhibitory reflex, less perirectal fibrosis and better sphincter
Conclusion
Our study showed that application of anchoring stitch reduces rectal prolapse and soiling in laparoscopic assisted anorectal pullthrough. Long term satisfactory defecative function was demonstrated in this follow up study.
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Cited by (19)
After anoplasty for anorectal malformations: Issues continue in adolescence and adulthood
2023, Seminars in Colon and Rectal SurgeryRectal Prolapse Following Repair of Anorectal Malformation: Incidence, Risk Factors, and Management
2023, Journal of Pediatric SurgeryAssessing the previously repaired patient with an anorectal malformation who is not doing well
2020, Seminars in Pediatric SurgeryCitation Excerpt :The amount of tension must be carefully assessed as too much could result in dehiscence and stricture. Others recommend application of an anchoring stitch to tack the rectum to the presacral fascia during laparoscopic assisted anorectoplasty (LAARP).31 Most of these maneuvers depend on the pelvic musculature, which if deficient will more likely allow for prolapse.28
Minimal dissection of posterior wall of rectum reduces rectal prolapse in laparoscopic assisted anorectal pull-through
2020, Journal of Pediatric SurgeryCitation Excerpt :LAARP has been a feasible surgical option for ARM with rectourethral fistula since its description by Georgeson in 2000 [1]. Previous studies have described that LAARP has benefits over PSARP such as excellent visualization of the fistula, better cosmetic outcomes, decreased wound infection and pain, and better functional outcomes [8,13–15]. On the other hand, a few authors have raised a concern that LAARP shows more postoperative complications such as posterior urethral diverticulum and rectal prolapses than PSARP [9,10,16–19].
Assessing the long term manometric outcomes in patients with previous laparoscopic anorectoplasty (LARP) and posterior sagittal anorectoplasty (PSARP)
2018, Journal of Pediatric SurgeryCitation Excerpt :The center of the external muscle sphincter was identified with an electrical stimulator to assist the pullthrough of the rectum into the most appropriate position. After anoplasty, an intracorporeal suture was applied to secure the rectum to the sacral fascia in order to prevent rectal prolapse [9]. Manometric study was carried out with a high resolution manometry system (Medical Measurement Systems [MMS]) as a day procedure without anesthesia.
Laparoscopic posterior rectopexy (Well's procedure) for full-thickness rectal prolapse following laparoscopic repair of an anorectal malformation: A case report
2018, International Journal of Surgery Case ReportsCitation Excerpt :However, Jung et al., 2013 concluded that suture rectopexy is ineffective in treating RP secondary to LAARP repair of anorectal malformations [14]. Nevertheless, an anchoring stitch during LAARP has been advocated as an effective technique in preventing RP, as RP occurrence was significantly reduced in the group with anchoring stitch (20%) versus without anchoring stitch (64%) [15]. Overall, reported recurrence rates of RP after suture rectopexy substantially differ and range from 0% [16] to 100% [17].
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Conflicts of Interest and Source of Funding: No conflicts of interests or source of funding to be disclosed.