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Oral Presentation - 24
Laparoscopic Assisted Repair Of High Imperforate Anus In Male Neonates
Hesham Elsaket, Khaled Hussien, Ahmed Fares, Mosatafa Gad, Ahmed Azzam
Pediatric Surgery Department , Cairo University
Purpose of the study: To test (evaluate) the effectiveness of laparoscopic-assisted anorectal pull through for newborns with high imperforate anus in males.
Patients and methods: A Prospective clinical trial outcome study involving 5 patients with high and intermediate types of imperforate anus in males. A preoperative ascending cystourtherogram has been performed routinely for all the patients at day 1 which has shown a great significance to detect the site of the fistula. The baby is placed supine on the table with 3 ports inserted one for the camera and 2 working channels for 3 mm ports. Dissection of the rectum after proper deflation of the rectal pouch till reaching its tapered end indicating the fistula site. Ligation of the fistula using 3/0 vicryl sutures then the rectal pull-through and anoplasty as a final stage.
Results: We evaluated 5 newborn males with high imperforate anus. Of these patients, 3 underwent primary laparoscopic repair on day 1 to day 2 of life. Whereas the other 2 patient had a simple loop sigmoid colostomy at day 1 or 2 followed by laparoscopic pull-through 5 days later. With regard the fistula site, , 3 cases were found to have recto- bladder neck fistulas, whereas the other 2 had recto-prostatic urethra fistulas. All patients passed stool within the first 48 hours postoperatively.
Conclusion: Our early results using primary laparoscopic repair appear encouraging. Laparoscopy allows excellent visualisation and assessment of the fistula and repair of high imperforate anus without need for colostomy. Long-term follow-up will be needed to assess outcomes and continence rates.