Long-Term Functional Evaluation of Fecal Continence After Laparoscopic-Assisted Pull-Through for High Anorectal Malformations

El-Debeiky, Mohamed S.; Safan, Hatem A.; Shafei, Ihab A.; Kader, Hesham A.; Hay, Sameh A.
April 2009
Journal of Laparoendoscopic & Advanced Surgical Techniques;Apr2009 Supplement 1, Vol. 19, ps51
Academic Journal
Background: The use of laparoscopy while performing an abdominal dissection for the mobilization of rectovesical fistula should have an impact on anorectal function, as compared to the original posterior sagittal anorectoplasty, where muscle complex was not cut and the rectum was pulled in a way similar to the old techniques for the abdominoperineal pull-through. This necessitates a functional reevaluation. Materials and Methods: A prospective case study included 15 patients treated with a laparoscopic-assisted pull-through for high anorectal malformation. Laparoscopy was used for abdominal dissection and ligation of the fistula, with the pull-through completed by a small perineal incision centered over the external sphincter. Nine of them are now older than 3 years for fecal continence evaluation. After the approval of the Ethical Committee for Medical Research in the Department of Surgery at Ain Sams University (Cairo, Egypt) and obtaining an informed consent from the parents, they were subjected to a full clinical history and a checklist about motions and soiling to be filled in over 1 month, a barium enema to check for any dilatation, anorectal manometry to evaluate resting pressure, maximum squeezing pressure, and sphincter relaxation, and MRI (magnetic resonance imaging) to evaluate the central situation of the rectum within the sphincter and the degree of development of the sphincter. Their degree of continence was graded according to the Kelly score. Results: Six of 9 patients are clean without any attacks of fecal soiling or incontinence, and they evacuate spontaneously but need the application of a rectal suppository for evacuation from time to time. The remaining 3 patients had variable degrees of fecal incontinence. One of them had mucosal prolapse and was excised with good cleanliness postoperatively. The remaining 2 patients are managed by medical control and they are clean with minimal soiling when stools are loose. MRI and barium enema showed a centrally placed rectum in the muscle complex without dilatation in all cases. Manometry showed a high resting pressure that decreased on straining in the 7 clean patients and low in 2. The resting pressure did not increase on squeezing and all showed weak rectoanal inhibitory reflex (RAIR). One patient developed dysurea and constipation 1 year after surgery, as diagnosed by VCUG (voiding cystourethrogram) to have a diverticulum at the site of excised fistula causing rectal and urethral obstruction treated by a transabdominal excision with a good functional result. Conclusion: The state of continence with the laparoscopic technique in high anorectal malformations in this study showed acceptable results but needs bigger series with longer follow-up for a proper evaluation of this technique.


Related Articles

  • Minimally Invasive Surgery for Anorectal Malformation in Boys: A Multicenter Study. Podevin, Guillaume; Petit, Thierry; Mure, Pierre Yves; Gelas, Thomas; Demarche, Martine; Allal, Hossein; Becmeur, François; Varlet, François; Philippe, Paul; Weil, Dominique; Heloury, Yves // Journal of Laparoendoscopic & Advanced Surgical Techniques;Apr2009 Supplement 1, Vol. 19, ps233 

    Introduction: The laparoscopic pull-through for high imperforate anus in boys has recently been developed in France and Benelux. The purpose of this study was to evaluate technical difficulties and surgical complications of this approach. Patients and Methods: This report was based on a...

  • Access for Laparoendoscopic Single Site Surgery. Ross, Sharona B.; Clark, C. Whalen; Morton, Connor A.; Rosemurgy, Alexander S. // Diagnostic & Therapeutic Endoscopy;2010, p1 

    Laparoscopic surgery is the standard of care for many abdominal and pelvic operations and is widely applied today. LESS (Laparo- Endoscopic Single Site) surgery, originally attempted in the 1990s, is an advanced minimally invasive approach that allows laparoscopic operations to be undertaken...

  • Fewer adhesions induced by laparoscopic surgery? Gutt, C. N.; Onlu, T.; Schemmer, P.; Mehrabi, A.; Büchler, M. W. // Surgical Endoscopy;Jun2004, Vol. 18 Issue 6, p898 

    Background: Laparoscopic surgery has potential theoretical advantages over open surgery in reducing the rate of adhesion formation, but very few comparative studies are available to prove this. Methods: A literature search was performed within Medline and Cochrane databases using the key words:...

  • Use of the surgical towel in colorectal hand-assisted laparoscopic surgery (HALS). Nakajima, K.; Milsom, J. W.; Margolin, D. A.; Szilagy, E. J. // Surgical Endoscopy;Mar2004, Vol. 18 Issue 3, p552 

    The use of laparotomy pads or towels to displace the small intestine away from the operative site is a well-established technique in open surgery; however, its application is unfeasible or extremely challenging in standard laparoscopic surgery. We describe the use of standard surgical towels in...

  • Laparoscopic Surgery: What Is Scientifically Demonstrated At Present? Cebrián, J. Ma. Fernández; Balaguera, J. Carvajal; Segovia, J. Camuñas // Internet Journal of Surgery;2007, Vol. 9 Issue 1, p9 

    Laparoscopic surgery (LS) has supposed a true revolution in the conventional surgery, until the point that at the present time most of the abdominal procedures can be made by this approach; however only 20% of the interventions that are carried out for this approach they are validated with the...

  • Laparoscopic diagnosis and treatment of intestinal obstruction. Franklin Jr, M. E.; Gonzalez Jr, J. J.; Miter, D. B.; Glass, J. L.; Paulson, D.; Franklin, M E Jr; Gonzalez, J J Jr // Surgical Endoscopy;Jan2004, Vol. 18 Issue 1, p26 

    Background: Intestinal obstruction is a common reason for general surgical referral. The traditional approach has been conservative management, followed by laparotomy if conservative measures are unsuccessful. However, with the advent of minimally invasive surgery, the need for...

  • Through the keyhole. Greenhalgh, Trisha // Accountancy;Dec2001, Vol. 128 Issue 1300, p63 

    This article discusses some of the issues that need to be considered by any individual who intends to undergo laparoscopic or keyhole surgery. The author notes that if you are contemplating a forthcoming operation, you should probably consider for key questions. First, how technically difficult...

  • Safety of open technique for first-trocar placement in laparoscopic surgery: a series of 6,000 cases. Lal, Pawanindra; Vindal, Anubhav; Sharma, Rajeev; Chander, Jagdish; Ramteke, Vinod // Surgical Endoscopy;Jan2012, Vol. 26 Issue 1, p182 

    Background: The open technique for the placement of the first trocar in laparoscopic surgery has become the preferred method due to the reduced number of complications associated with it. In 2002 we reported our technique, which has been widely accepted at many centers, including all the units...

  • Natural Orifice Translumenal Endoscopic Surgery (NOTES) Towards Brighter Future. Abbas, S.; Rizvi, R. // World Journal of Laparoscopic Surgery;Jan-Apr2010, Vol. 3 Issue 1, p19 

    In natural orifice translumenal endoscopic surgery (NOTES) intentional puncture of one of the viscera (e.g., stomach, rectum, vagina, and urinary bladder) is made and an endoscope is used to access the abdominal cavity and perform an intra-abdominal operation. Early studies focused on...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics