Comparison of postoperative urinary complications in laparoscopic-assisted anorectoplasty versus posterior sagittal anorectoplasty for anorectal malformation with rectourethral fistula

• Published in: Pediatric surgery international 2024-04, Vol.40 (1), p.111, Article 111
• Main Authors: Takimoto, Atsuro, Fumino, Shigehisa, Iguchi, Masafumi, Takayama, Shohei, Kim, Kiyokazu, Aoi, Shigeyoshi, Ono, Shigeru
• Format: Article
• Language: English
• Subjects: Anal Canal - abnormalities; Anorectal Malformations - complications; Anorectal Malformations - epidemiology; Anorectal Malformations - surgery; Bladder; Fistula; Humans; Infant; Laparoscopy; Laparoscopy - adverse effects; Medicine; Medicine & Public Health; Original Article; Pediatric Surgery; Pediatrics; Postoperative Complications - etiology; Rectal Fistula - complications; Rectal Fistula - surgery; Rectum - abnormalities; Rectum - surgery; Retrospective Studies; Surgery; Treatment Outcome; Urethra - surgery; Urethral Diseases - etiology; Urethral Diseases - surgery; Urinary Bladder, Neurogenic - etiology; Urinary Fistula - etiology; Urinary Fistula - surgery
• ISSN: 1437-9813; 0179-0358; 1437-9813
• DOI: 10.1007/s00383-024-05692-2

Background Long-term urinary outcomes after anorectal malformation (ARM) repair are affected by surgical approach and sacral anomalies. This study aimed to compare laparoscopic-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) in terms of urinary complications. Methods Between 2001 and 2022, 45 patients were treated with LAARP or PSARP. The rectourethral fistula and inflow angle between the fistula and rectum was confirmed by preoperative colonography. The incidence of urinary complications and treatment were compared between the two groups. Results Four patients (14%) had remnant fistula and five patients (17%) had neurogenic bladder dysfunction in LAARP group, while three patients (18%) had urethral injury in PSARP group. All patients with remnant fistula were asymptomatic and followed without treatment. The incidence of remnant fistula improved between earlier decade and later decade. In all cases with urethral injury, suture repair was performed and no postoperative leakage was noted. All five patients with neurogenic bladder dysfunction had spine abnormalities that required clean intermittent catheterization (CIC) and two were free from CIC finally. Conclusions It is important to check inflow angle preoperatively to prevent remnant fistula. For PSARP, meticulous dissection is required when separating fistula from urethra because they create common wall. The most contributing factor to neurogenic bladder is sacral anomalies. Preoperative evaluation and postoperative urinary drainage are important.