Comparison of postoperative urinary complications in laparoscopic-assisted anorectoplasty versus posterior sagittal anorectoplasty for anorectal malformation with rectourethral fistula
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In brief
In brief
This comparative study evaluates urinary complications following two surgical approaches for anorectal malformations with rectourethral fistula in 45 pediatric patients. LAARP showed 14% remnant fistula rate and 17% neurogenic bladder, while PSARP had 18% urethral injury requiring repair. Sacral anomalies were the primary factor in bladder dysfunction.
- LAARP had 14% remnant fistula rate (asymptomatic, no treatment needed) vs PSARP had 18% urethral injury rate (required suture repair).
- Preoperative colonography to assess rectourethral fistula inflow angle is critical for preventing remnant fistula in LAARP.
- Neurogenic bladder (17% in LAARP) correlates with sacral anomalies, not surgical approach; requires CIC with potential for resolution.
- PSARP requires meticulous dissection at the common wall between fistula and urethra to prevent intraoperative urethral injury.
- Remnant fistula incidence improved over time with surgical experience, emphasizing the learning curve in LAARP technique.
Written by the GCMD Library team from the article.
Abstract
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.