Slater Bethany J, Kay Saundra, Rothenberg Steven S
Rocky Mountain Hospital for Children , Denver, Colorado.
J Laparoendosc Adv Surg Tech A. 2018 Jun;28(6):780-783. doi: 10.1089/lap.2017.0111. Epub 2018 Feb 15.
Laparoscopic anorectoplasty (LARRP) for the treatment of select anorectal malformations has gained popularity due to enhanced visualization of the fistula and the ability to place the rectum within the sphincter complex while minimizing division of muscles and the perineal incision. However, given the technical challenges and reported complications of ligation, a number of techniques have been described, including using clips, suture ligation, endoloops, or division without closure. We aimed to evaluate fistula closure and division for high imperforate anus using a 5-mm stapler (JustRight Surgical, Boulder, CO).
A retrospective chart review was performed on patients who underwent LAARP for imperforate anus between March 2015 and December 2016.
Four patients underwent LAARP with division of the fistula using the 5-mm stapler. The average age was 3.2 months and average weight was 4.5 kg. The location of the fistula was rectoprostatic in 3 cases and rectobladder neck in 1 case. There were no complications.
Division of a fistula at or above the level of the prostate can safely and effectively be performed with the 5-mm stapler. The stapler allows for division flush with the urethra or bladder ergonomically and quickly.
腹腔镜肛门直肠成形术（LARRP）用于治疗特定的肛门直肠畸形，因其能更好地观察瘘管，且能将直肠置于括约肌复合体中，同时最大限度减少肌肉分离和会阴切口，故而受到欢迎。然而，鉴于结扎存在技术挑战及已报道的并发症，已描述了多种技术，包括使用夹子、缝合结扎、内镜圈套器或不闭合的分离术。我们旨在评估使用5毫米吻合器（JustRight Surgical，科罗拉多州博尔德市）对高位肛门闭锁进行瘘管闭合和分离的效果。
对2015年3月至2016年12月期间接受LARRP治疗肛门闭锁的患者进行回顾性病历审查。
4例患者接受了使用5毫米吻合器进行瘘管分离的LARRP。平均年龄为3.2个月，平均体重为4.5千克。3例瘘管位于直肠前列腺部，1例位于直肠膀胱颈部。无并发症发生。
使用5毫米吻合器可安全有效地在前列腺水平或以上进行瘘管分离。该吻合器能在人体工程学上方便快捷地与尿道或膀胱齐平进行分离。
