LAPAROSCOPIC ASSISTED ANORECTAL PULL-THROUGH FOR HIGH IMPERFORATE ANUS: THREE YEARS EXPERIENCE

Background/Purpose The aim of this report is to describe our three years experience with the Laparoscopic Assisted Anorectal Pull-through for High Imperforate Anus (LAARP) using the laparoscopic muscle electrostimulation. Methods In the Dept of Pediatric Surgery of the University of Bologna, from: March 2001 to March 2004, eight patients, with a diagnosis of high anorectal malformations under- went a LAARP. The patients, all males and aged from 4 to 9 months (mean age 5.8 months), presented a recto-ureth- ral fistula. The following associated malformations were described: sacral malformation, laryngeal stenosis, urethral duplication, multicystic kidney, non palpable testis and esophageal atresia. All were treated with a colostomy in the newborn period followed by a delayed LAARP. The laparoscopic step was characterized by the stimulation of the puborectal muscle, using a modified Peña electrosti- mulator introduced via a trocar. All patients underwent a post operative period of anal dilatations. Results In seven cases the LAARP was succesful while in one case, due to a strong tension from the colostomy, a con- version to open technique, was needed. Conclusion Although an evaluation regarding the continence is to be followed up, we consider the LAARP the treatment of choice for the high imperforate anus. It offers the ad- vantage of a good visualization of the fistula and of the surrounding structures and minimally invasive abdominal and perineal wounds.With the laparoscopic Peña stimu- lator the direct observation of the puborectal slings con- traction allows an evaluation of the functional contracti- lity and an accurate colonic pull through in the centre of the muscle complex.