Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People's Republic of China.
Department of Paediatric Surgery, Monash Children's, Monash Medical Center, Southern Health, Clayton, Australia.
Surg Endosc. 2021 Apr;35(4):1921-1926. doi: 10.1007/s00464-020-08268-y. Epub 2021 Feb 1.
For the last 20 years, laparoscopy management of anorectal malformations (ARM) has been challenged due to the development of postoperative urethral diverticulum or injury caused by the imprecise transection of rectourethral fistulae, particularly rectobulbar fistulae situated deep in the pelvis. We have developed a combined approach of enteroscopy and laparoscopy for intraluminal incision of a rectourethral fistula.
We retrospectively reviewed 47 ARM patients who underwent surgical corrections using the combined approach between January 2019 and June 2020. Early postoperative and subsequent follow-up results were evaluated.
The median follow-up period was 12 months. The average age at surgery was 3.18 ± 0.64 months. The mean operative time of a single-incision laparoscopic-assisted anorectoplasty (SILAARP) was 1.19 ± 0.29 h. The time for intraluminal incision of the fistula was shortened from 14 to 2 min. No patients underwent a conversion. The average postoperative hospital stay, time to full feeds and placement of an anal tube were 10 days, 1 day, and 5 days, respectively. No urethral diverticulum, urinary injury, wound infection, rectal retraction, anal stenosis or rectal prolapse was encountered in the cohort.
The combined enteroscopy and laparoscopy approach offers precise management of rectourethral fistulae. It could effectively obviate urethral complications, eliminating the obstacles of laparoscopy application in the management of ARMs.
在过去的 20 年中，由于术后尿道憩室的形成或由于直肠尿道瘘（尤其是位于骨盆深部的直肠球部瘘）的不精确横断而导致的损伤，腹腔镜处理肛门直肠畸形（ARM）受到了挑战。我们开发了一种内镜和腹腔镜联合入路，用于直肠尿道瘘的腔内切开。
我们回顾性分析了 2019 年 1 月至 2020 年 6 月期间采用联合入路手术治疗的 47 例 ARM 患者。评估了早期术后和随后的随访结果。
中位随访时间为 12 个月。手术时的平均年龄为 3.18±0.64 个月。单切口腹腔镜辅助肛门成形术（SILAARP）的平均手术时间为 1.19±0.29 小时。瘘管腔内切开的时间从 14 分钟缩短至 2 分钟。无患者转为开放手术。术后平均住院时间、完全经口喂养时间和肛门管放置时间分别为 10 天、1 天和 5 天。该队列中未发生尿道憩室、尿道损伤、伤口感染、直肠回缩、肛门狭窄或直肠脱垂。
内镜和腹腔镜联合入路可精确处理直肠尿道瘘。它可以有效地避免尿道并发症，消除腹腔镜在 ARM 治疗中的应用障碍。
