Purpose

To determine if minimal dissection of the posterior wall of rectum can reduce rectal prolapse after laparoscopic assisted anorectal pull-through (LAARP) in male anorectal malformation (ARM) with rectourethral fistula.

Methods

Eighty-six male patients with ARM who underwent LAARP in our center between 2007 and 2018 were retrospectively analyzed. There were 45 cases of prostatic urethral fistula, 24 bulbar urethral fistulas, and 15 bladder neck fistulas. Two patients had no fistula. To prevent rectal prolapses, we markedly shortened the length of posterior rectal dissection from mid-2016. Dissection of posterior wall of rectum was performed minimally around the level of the fistula and the dissected portion of the posterior rectum was significantly shorter than the previous cases. For comparative analysis, patients were divided into two groups (before and after application of minimal dissection of posterior wall of rectum): Group A, from 2007 to mid-2016 and Group B, from mid-2016 to 2018.

Results

There were 60 patients in Group A and 26 patients in Group B. Demographic characteristics were not significantly different between the two groups. The median follow-up duration was 52.4 months for Group A and 26.9 months for Group B. Group B had lower incidence of rectal prolapse (11.5%) than Group A (68.3%) (p < 0.001). Upon our subgroup analysis based on types of fistula, patients with recto-prostatic urethral fistula and recto-bulbar urethral fistula showed significant reduction in the incidence of rectal prolapse (both p < 0.001). However, patients with recto-bladder neck fistula showed no statistical significance (p = 0.264).

Conclusion

Minimal dissection of the posterior wall of rectum can reduce rectal prolapse in LAARP.

Level of evidence

III. Retrospective Comparative Treatment Study

中文翻译：

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直肠后壁的最小解剖减少了腹腔镜辅助肛门直肠穿刺术中的直肠脱垂。

目的

为了确定直肠后壁的最小解剖是否可以减少腹腔镜辅助肛门直肠畸形（ARM）合并直肠tour门瘘的腹腔镜辅助肛门直肠穿刺术（LAARP）后的直肠脱垂。

方法

回顾性分析了2007年至2018年在我中心接受LAARP治疗的86例男性ARM患者。前列腺尿道瘘45例，延髓性尿道瘘24例，膀胱颈瘘15例。2例患者无瘘管。为了防止直肠脱垂，我们从2016年中开始显着缩短了直肠后解剖的时间。直肠后壁的解剖仅在瘘管水平附近进行，并且直肠后的解剖部分明显短于先前病例。为了进行比较分析，将患者分为两组（在进行直肠后壁最小解剖之前和之后）：A组从2007年至2016年中，B组从2016年中至2018年。

结果

A组有60例患者，B组有26例患者。两组的人口统计学特征无明显差异。A组的中位随访时间为52.4个月，B组的中位随访时间为26.9个月。B组的直肠脱垂发生率（11.5％）低于A组（68.3％）（p <0.001）。根据我们根据瘘管类型进行的亚组分析，直肠前列腺尿道瘘和直肠球型尿道瘘患者的直肠脱垂发生率显着降低（均为p <0.001）。但是，直肠膀胱颈瘘患者没有统计学意义（p = 0.264）。

结论

直肠后壁的最小解剖可以减少LAARP的直肠脱垂。

证据水平

三，回顾性比较治疗研究