EN
TÜRKÇE
Oral Presentation - 45
Comparison of the outcomes of Laparoscopic-Assisted Anorectoplasty and Posterior Sagittal Anorectoplasty in male pediatric patients with intermediate and high variety of anorectal malformations at a single center in a Low- and middle-income country
Md. Mozammel Hoque
Chattogram Maa-0-Shishu Hospital Medical College
Background: Male babies with intermediate and high variety of anorectal malformations (ARMs) are typically treated using a staged approach (3 stages). Two effective surgical techniques for addressing ARMs are Posterior Sagittal Anorectoplasty (PSARP) and Laparoscopically Assisted Anorectoplasty (LAARP). This study is based on our experience, comparing postoperative complications and long-term outcomes to evaluate the effectiveness of two different approaches.
Methods: This study was conducted in the Department of Pediatric Surgery at Chattogram Maa-O-Shishu Hospital Medical College over a decade, from January 2013 to October 2024. A total of 154 male children with intermediate and high variety of ARMs who underwent anorectoplasty were divided into two groups: Group A (LAARP) and Group B (PSARP) by simple randomization. The functional outcomes of children older than 3 years were assessed using the Krickenbeck scoring system, which was applied by interviewing their parents.
Results: The median age at anoplasty was 10 months (IQR: 7 to 15 months). The post-operative complications were slightly higher in the PSARP Group than in the LAARP Group, although the difference was statistically insignificant. Specifically, post-operative wound infection and dehiscence were developed in twenty-one patients (9 vs 12), retraction of the rectum in seven patients (2 vs 5), anal stenosis in five patients (3 vs 2), and rectal prolapse in seven patients (2 vs 5). In Group A, no urological complications occurred post-operatively. However, in Group B, four patients suffered from urinary incontinence, which was managed by CIC (Clean Intermediate Catheterization).
During the follow-up period, the rate of voluntary bowel movement was 85.7% (66/77) in Group A and 80.5% (62/77) in Group B (P=.12). Soiling and pseudo-incontinence were affecting 6.5% of patients in Group A compared to 9.1% in Group B. Grade III constipation was less common in the LAARP group (3.9%) than in the PSARP group (5.2%).
Conclusions: The LAARP demonstrated a reduction in postoperative complications and improved functional outcomes compared to the PSARP for the treatment of intermediate and high variety ARMs.