Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Basni Industrial Area, MIA, 2nd Phase, Basni, Jodhpur, 342005, India.
Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, London, UK.
Pediatr Surg Int. 2020 Nov;36(11):1299-1307. doi: 10.1007/s00383-020-04748-3. Epub 2020 Sep 26.
This study reviewed the literature on the postoperative complications following laparoscopic-assisted anorectoplasty (LAARP).
A Medline and Embase search was performed for the terms "anorectal malformation" (ARM) "laparoscopic" and "complication". Articles without English full text, review articles, systematic reviews, case reports, case series < 5 cases and duplicate articles were excluded. Two reviewers independently performed the eligibility assessment and data extraction. Data were collected for type of malformation, surgical technique, postoperative complications and functional outcomes RESULTS: The search retrieved 108 articles, of which 38 met the inclusion criteria and offered 1058 patients for analysis. Rectoprostatic and rectobladder neck fistula were the most common types of ARM in males, whereas it was the common cloaca in females. Analysis of complications demonstrated rectal prolapse (n = 149; 14.08%) being the most prominent, followed by urethral diverticulum (n = 32; 3.02%), anal stenosis (n = 37; 3.49%), recurrent fistula (n = 7; 0.66%) and rectal stricture (n = 4; 0.37%). Krickenbeck classification was used for functional assessment in 638 patients, with fecal soiling grade 2 or > 2 in 79. Data on functional outcome specific to the type of malformation was available for 246 patients: fecal soiling grade 2 or > 2 in 15/94 (15.95%) with rectoprostatic fistula, 26/73 (35.61%) with rectobladder neck fistula, 6/47 (12.76%) with common cloaca, and 1/22 (4.54%) with no fistula.
Rectal prolapse, posterior urethral diverticulum and anal stenosis are the most common complications after LAARP. Inconsistent and non-uniform functional assessment and non-availability of information about the sacrum and spine make it difficult to analyze the functional outcome following LAARP.
本研究回顾了腹腔镜辅助肛门直肠成形术（LAARP）术后并发症的文献。
在 Medline 和 Embase 上检索了“肛门直肠畸形（ARM）”“腹腔镜”和“并发症”等术语。排除了没有英文全文、综述文章、系统评价、病例报告、病例系列<5 例和重复文章的文章。两位评审员独立进行了资格评估和数据提取。收集的数据包括畸形类型、手术技术、术后并发症和功能结果。
检索到 108 篇文章，其中 38 篇符合纳入标准，共分析了 1058 例患者。直肠前列腺和直肠膀胱颈瘘是男性中最常见的 ARM 类型，而女性中最常见的是共同肛道。并发症分析表明，直肠脱垂（n=149；14.08%）最为突出，其次是尿道憩室（n=32；3.02%）、肛门狭窄（n=37；3.49%）、复发性瘘（n=7；0.66%）和直肠狭窄（n=4；0.37%）。638 例患者采用 Krickenbeck 分类进行功能评估，其中 79 例粪便污染程度为 2 级或>2 级。246 例患者提供了特定于畸形类型的功能结果数据：直肠前列腺瘘 15/94（15.95%）、直肠膀胱颈瘘 26/73（35.61%）、共同肛道 6/47（12.76%）和无瘘管 1/22（4.54%）。
LAARP 术后最常见的并发症是直肠脱垂、后尿道憩室和肛门狭窄。功能评估不一致且不统一，并且没有关于骶骨和脊柱的信息，这使得难以分析 LAARP 后的功能结果。
