[Comparison of laparoscopic-assisted anorectoplasty and posterior sagittal anorectoplasty for high and intermediate anorectal malformations].

OBJECTIVE: To compare the efficacy of laparoscopic-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) for high and intermediate anorectal malformation (ARM).

METHODS: Clinical data 60 children with high and intermediate ARM who underwent LAARP (40 cases of three-port laparoscopy, 20 cases of transumbilical single incision laparoscopy ) between January 2010 to December 2014 were retrospectively analyzed. Clinical data of 36 children with high and intermediate ARM who underwent PSARP between January 1992 to December 2002 were used as control. The duration of operation, blood loss, hospital stay, postoperative complications and long-term anal function were compared between two groups. Krickenbeck classification was applied to assess the anorectal function.

RESULTS: Baseline data, such as gender, age at operation, sacral index and proctatresia site, were not significantly different between two groups. As compared to PSARP group, LAARP group presented shorter operative time [(113±13) min vs. (132±10) min, P=0.01], less operative blood loss [(11.5±1.6) ml vs. (14.3±1.7) ml, P=0.03], shorter postoperative hospital stay [(6.9±0.7) d vs. (8.2±0.8) d, P=0.02] and lower morbidity of postoperative complication [11.7% (7/60) vs. 27.8% (10/36), P=0.02]. Postoperative defecation evaluation showed that LAPPR group had lower percentage of 2-3 grade constipation than PSARP group [0% vs. 22.2%(8/36), P=0.00]. While percentage of 2-3 grade voluntary bowel movement [5.9% (3/51) vs. 16.7% (6/36), P=0.20] and percentage of 2-3 grade soiling [5.9%(3/51) vs. 16.7%(6/36), P=0.20] were not significantly different between two groups.

CONCLUSIONS: LAARP is safe and effective in the treatment of high and intermediate ARM. Compared with PSARP, LAARP has some advantages, such as better cosmetic results and faster recovery.