Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, People's Republic of China.
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.
Pediatr Surg Int. 2020 Oct;36(10):1213-1219. doi: 10.1007/s00383-020-04730-z. Epub 2020 Aug 14.
Laparoscopic-assisted anorectoplasty (LAARP) is considered to benefit the male patients with anorectal malformation (ARM). This study evaluates LAARP management for intermediate type rectovestibular fistula (IRVF) in the female patient with ARM.
Twelve patients with IRVF (aged 3-5 months) underwent LAARP from 2017 to 2019 in our institute. LAARP was performed for mobilization of the rectum, visualization and enlargement of the center of the sphincter muscle complex (SMC) from pelvic and perineal aspects, intra-fistula mucosectomy and rectal pull-through in the SMC with the fourchette and the perineal body unattached.
LARRP was performed in all patients without conversion to open procedure. No patient suffered from wound infection, vaginal injury, recurrent fistula and anal stenosis. The parents were satisfied with the appearance of the wound. Rectal prolapse developed in one patient and needed surgical correction. The patients were followed up for a mean of 19.7 months (ranged from 12 to 35 months).
Our preliminary experience shows that LAARP offers an alternative method of correction for the IRVF with good visualization of the SMC and may diminish the risks of wound dehiscence and vaginal injury.
腹腔镜辅助肛门直肠成形术（LAARP）被认为有益于男性肛门直肠畸形（ARM）患者。本研究评估了 LAARP 治疗女性 ARM 患者中间型直肠前庭瘘（IRVF）的效果。
2017 年至 2019 年，本研究所对 12 例 IRVF（年龄 3-5 个月）患者进行了 LAARP。LAARP 用于直肠的游离，从骨盆和会阴两个方向观察和扩大括约肌复合体（SMC）的中心，在瘘管内进行黏膜切除术，并将直肠穿过 SMC，会阴体和四叉骨不附着。
所有患者均成功完成了 LAARP，无中转开放手术。无患者发生伤口感染、阴道损伤、复发性瘘管和肛门狭窄。家长对伤口的外观满意。一名患者出现直肠脱垂，需要手术矫正。患者平均随访 19.7 个月（12-35 个月）。
我们的初步经验表明，LAARP 为 IRVF 提供了一种替代的矫正方法，可良好地观察 SMC，并可能降低伤口裂开和阴道损伤的风险。
