Functional Outcome in Patients With Anorectal Malformation With Recto-prostatic or Recto-bulbar Urethral Fistula and Comparison Between Different Surgical Approaches: A Multi-center Study

• Published in: Journal of pediatric surgery 2024-08, p.161652, Article 161652
• Main Authors: Wong, Carol Wing Yan, Koga, Hiroyuki, Sugita, Koshiro, Kato, Daiki, Mutanen, Annika, Chung, Patrick Ho Yu, Miyano, Go, Harumatsu, Toshio, Ieiri, Satoshi, Nakagawa, Yoichi, Uchida, Hiroo, Pakarinen, Mikko P., Wong, Kenneth Kak Yuen
• Format: Article
• Language: English
• Subjects: Anorectal malformation; Functional outcome; Recto-bulbar urethral fistula; Recto-prostatic urethral fistula
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2024.07.037

To analyze and compare the outcomes in patients with anorectal malformation with rectoprostatic and rectourethral fistula between laparoscopic-assisted anorectoplasty (LAARP) versus posterior sagittal anorectoplasty (PSARP). We performed a retrospective review on all males with anorectal malformation (ARM) with recto-prostatic (ARM-RP) or recto-bulbar urethral fistula (ARM-RB) treated in five tertiary paediatric surgical centres in the past 25 years. Defecative function was assessed using the Krickenbeck classification and Kelly's score. Functional outcomes between patients with LAARP and PSARP were compared. There were a total of 136 males with ARM-RP and ARM-RB for analysis, among which 73 (53.7%) had ARM-RP and 63 (46.3%) had ARM-RB. The median age of the patients was 9.4 years (range 0.8–24.7 years) and the median age at operation was 0.4 years (0 day–3.1 years). 57 (41.9%) and 79 patients (58.1%) underwent PSARP and LAARP respectively. 34 patients (25%) had VACTERL association. 111 (81.6%) and 103 patients (75.7%) had sacral and spinal cord anomalies respectively. 19 patients (13.9%) eventually required Malone's Antegrade Continence Enema (MACE). For the comparison between PSARP and LAARP, no difference in Kelly scores (4.58 ± 1.63 versus 4.67 ± 1.36) was identified (p = 0.79). Logistic regression for voluntary bowel movement showed that VACTER association (p = 0.02) and fistula location (p = 0.01) were significant prognostic factors, whereas the operation approach (PSARP or LAARP) was not (p = 0.65). VACTERL association and fistula location were significant prognostic factors for voluntary bowel movement, and there appeared to be no significant difference in functional outcome between PSARP and LAARP. IV. •There is controversy in the optimal surgical approach in the treatment of males with recto-prostatic and recto-bulbar urethral fistula.•Larger cohort studies comparing LAARP versus PSARP in these patients are lacking.•This is a multi-center study (one paediatric surgical centre from Hong Kong, three from Japan and one from Helsinki) on the comparison of functional outcome between LAARP and PSARP in the above mentioned group of patients.