Management of anorectal malformations in the era of laparoscopy

Abstract

Aim: Despite the advances of laparoscopic surgery in paediatric surgery, its role in anorectoplasty remains controversial. This review article aims at discussing current evidences regarding this new operative approach. Methods: Literature review for laparoscopic anorectoplasty was performed in combination with experience from our centre. Details on operative techniques, surgical complications and postoperative outcomes were highlighted. Results: Laparoscopic anorectoplasty (LAR) can be performed safely and effectively in early infantile period with modern small-sized laparoscopic instruments. Postoperative complications have been reported to range from 0.8 to 7.2 per cent. Apart from general surgical complications, fistula and cyst formations at the posterior urethra are two specific complications. Functional outcomes are not inferior to traditional posterior sagittal anorectoplasty (PSARP) with less surgical trauma and better cosmetic result especially in high-type malformations. Similarly, outcomes of LAR are comparable with PSARP under manometric and radiological assessments. Conclusions: Based on current evidences, LAR appears to be at least as good as PSARP. In high-type malformations, we recommend that LAR be considered as the operation of choice. However, good laparoscopic skills and proper laparoscopic instruments are essential when performing this operation. © 2014 College of Surgeons of Hong Kong.