Comparison of outcomes between laparoscopy-assisted and posterior sagittal anorectoplasties for male imperforate anus with recto-bulbar fistula

Purpose: All reports comparing laparoscopy-assisted anorectoplasty (LAARP) with posterior sagittal anorectoplasty (PSARP) in male high-type imperforate anus include a mix of recto-vesical, recto-prostatic, recto-bulbar, and absent fistula cases without focusing on recto-bulbar fistula (RBF), the most challenging type to treat laparoscopically. We compared LAARP with PSARP for treating only RBF. Method: We used our fecal continence evaluation questionnaire (FCE; maximumscore = 10), scoring of magnetic resonance imaging (MRI) findings (MRI scores), and the angle between the rectum and the anal canal (RAA) to assess 20 RBF cases (LAARP = 12, PSARP = 8) treated from 2000 to 2013 prospectively. Results: Mean ages at surgery, MRI scores, mean RAA, and duration of raised C-reactive protein (6.6 vs. 6.7 days; p = NS) were similar. In all cases, postoperative MRI showed no residual fistula and normal urination. LAARP had consistently higher FCE (7.9 vs. 7.8 at 3 years; 8.6 vs. 8.3 at 5 years; 8.9 vs 8.6 at 7 years; p = NS, respectively), less wound infections (0 vs. 37.5%; p < 0.05), higher incidence of rectalmucosal prolapse (50.0 vs. 0%; p < 0.05), and required less analgesia (p < 0.05). Conclusion: Although LAARP and PSARP are comparable for treating RBF, LAARP is associated with less wound infections and higher incidence of rectal mucosal prolapse. (C) 2014 Elsevier Inc. All rights reserved.