One-Stage Laparoscopic-Assisted Anorectoplasty for Neonates with Anorectal Malformation and Recto-Prostatic or Recto-Bulbar Fistula According to the Krickenbeck Classification

Background: Congenital recto-urethral fistula (RUF) is the most common form of anorectal malformations (ARMs) found in boys. The aim of this study is to review our experience with one-stage laparoscopic procedure in the management of ARMs with recto-prostatic fistula and recto-bulbar fistula. Methods: Seventeen boys with congenital RUF who underwent one-stage laparoscopy-assisted anorectoplasty (LAARP) between July 2012 and June 2015 were retrospectively in the study. Results: All patients successfully underwent one-staged laparoscopic surgery without conversion. The recto-prostatic urethral fistula was encountered in 6 patients and recto-urethral bulbar fistula in 11 patients. The mean age at the time of surgery was 46.2 hours with mean length of hospital stay being 10.6 days. The operative times for the recto-urethral prostatic fistula and recto-urethral bulbar fistula were similar (128.2 versus 122.4 minutes, P=.091). Intraoperative blood loss was minimal. No injury to the urethra or vas deferens. The urethral catheter was removed on postoperative day 10. No one lost to follow-up. The median follow-up period was 2.6 years (range: 2-4 years). No recurrent fistula or urethral diverticulum was detected according to the voiding cystourethrography and pelvic MRI at 1 year. Conclusion: One-stage LAARP is safe and effective for neonates with recto-prostatic fistula and recto-bulbar fistula. It provides an alternative method to rectify the ARMs with recto-prostatic fistula and recto-bulbar fistula without colostomy.