Long-term outcomes of male imperforate anus with recto-urethral fistula: laparoscopy-assisted anorectoplasty versus posterior sagittal anorectoplasty

• Published in: Pediatric surgery international Vol. 38; no. 5; pp. 761 - 768
• Main Authors: Koga, Hiroyuki, Miyake, Yuichiro, Yazaki, Yuta, Ochi, Takanori, Seo, Shogo, Lane, Geoffrey J., Yamataka, Atsuyuki
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2022; Springer Nature B.V
• Subjects: Anal Canal - surgery; Anus; Anus, Imperforate - surgery; Defecation; Feces; Fistula; Follow-Up Studies; Humans; Infant; Laparoscopy; Magnetic resonance imaging; Male; Medicine; Medicine & Public Health; Original Article; Pediatric Surgery; Pediatrics; Questionnaires; Rectal Fistula - surgery; Rectum - surgery; Retrospective Studies; Standard deviation; Surgery; Treatment Outcome; Underwear; Imperforate anus; Posterior sagittal anorectoplasty; Recto-bulbar fistula; Laparoscopy-assisted anorectoplasty; Recto-prostatic fistula
• ISSN: 1437-9813; 0179-0358; 1437-9813
• DOI: 10.1007/s00383-022-05106-1

Purpose A five-parameter fecal continence evaluation questionnaire (FCEQ) and incidence of complications were used for long-term assessment of laparoscopy-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) for treating male imperforate anus (MIA) with rectobulbar (RB) or rectoprostatic (RP) fistulas. Methods Subjects were 64 consecutive Japanese MIA patients with RB or RP fistulas treated at a single institution between 1995 and 2021. FCEQ data collected retrospectively were used to calculate a fecal continence evaluation (FCE) score (best = 10) and coefficient of variation for FCE (FCECV). The statistical significance threshold was defined at  p  < 0.05. Results Fistulas were RB ( n  = 40; LAARP = 25/40, PSARP = 15/40) or RP ( n  = 24; LAARP = 17/24, PSARP = 7/24). Mean ages at surgery and status of the sacrum were similar ( p  = 0.06, 0.05 and 0.51). FCE scores in RP-LAARP were consistently higher with less FCECV but differences were only statistically significant from 7 years postoperatively ( p  < 0.05). While FCE scores for RB-LAARP and RB-PSARP were similar ( p  = 0.99), FCECV were lower for RB-LAARP compared with RB-PSARP. LAARP was associated with less-wound infections, but greater incidence of anal mucosal prolapse unrelated to preoperative status of the sacrum. Conclusion Long-term postoperative FCEQ assessment favored LAARP for treating MIA with either RB or RP fistulas.