Pérez-Lorenzana H, Licona-Islas CM, Zaldivar-Cervera J, Mora-Fol JR, Flores-Plascencia AE, Huacuz-Herrera LM

Language: Spanish
References: 12
Page: 70-76
PDF size: 244.99 Kb.

ABSTRACT

Introduction: Laparoscopically assisted anorectal pull-through (LAARP) is a new surgical option for patients with high anorectal malformations (HAM). OBJETIVE. Show our initial experience with LAARP technique and the primary manometrical evaluation of this patients.
Matrial and Methods: Prospective study including all patients treated with LAARP between July 2005 to November 2006. We analyzed age at time of LAARP, sex, type of anorectal malformation, procedure length and surgical findings, complications and anorectal manometry.
Results: Mean age was 8 months ( 4 to 18). Four of five patients were males. HAM founded wereHAM with vesicorectal fistulae (3) and two HAM with uretrorectal fistulae. All the patients had colostomy before LAARP. The mean length of surgery was 169 minutes ( 135 to 220’). One patient presents rectal retraction as complication, another one presents redundant anal mucosa, both patients were treated with anoplasty. Manometric diagnosis were normotense anal sphincter in 4 patients, one presents hipotense anal sphincter. Mean basal pressure was 49.5mmHg (24 to 58mmHg) and maximum basal pressure was 55.2 (29 to 64 mmHg). The length of anal sphincter was 1.5cm in 3 patients and 2cm in two. All the cases presents inhibitory anal reflex. Actual follow up its from 3 to 22 months.
Conclusions: Results obtained until now aloud us to recommend LAARP because its an effective and secure technique. Principal indications for this procedure are those complex HAM that requires combinated approach with all the advantages of minimally surgical procedures.

REFERENCES

1. Puri P, Höllwarth ME. Pediatric Surgery. Alemania Springer-Verlag Berlin Heidelberg Nueva York, 2006.289-312.

2. Naranjo HD, García FI, Borbolla BE, et al. La motilidad anorectal en sujetos sanos. Rev Cubana Biomed 2001; 20(3); 202-208.

3. Beck DE. Handbook of colorectal Surgery.2da edición. Nueva York, Marcel Dekker Inc, 2003:21- 25.

4. Gil-Vernet JM, Asensio M, Marhueda C, Wayar BA. Diecinueve años de anorectoplastia sagital posterior como tratamiento de la malformación anorectal. Cir Pediatr 2001;(14);108-111.

5. Georgeson KE, Inge TH, Albanese CT.Laparoscopically assisted anorectal pull throught for high imperforate anus. A new technique.Jour ped Surg 2001(35);927-931.

6. Kudou S, Iwanaka T, Kawashima H, Uchida A.Midterm follow –up study of high –type imperforate anus after laparoscopically assisted anorectoplasty. Jour Ped Surg 2005(40).1923-1926.

7. Bhat NA, Grover VP, Bhatnagar V. Manometric evaluation of postoperative patients with anorectal anomalies. Ind Jour Gastr 2004 (23);206-208.

8. Hatgûder G, Ates O, Caglar M, Olguner M, Akgur FM. A unique opportunity for the operative treatment of high anorectal malformation: Laparoscopy. Eur J Pediatr Surg 2006(16):449-455.

9. Raghupathy RK, Moorthy PK, Babuji N, NatarajanM, Kandhiya SG, et al. Laparoscopically assited anorectoplasty for high ARM. J Indian Assoc Pediatr Surg 2003 (9).202-207.

10. Lima M, Tursini S, Ruggeri G, Aquino A, Gargano T, De Biagi L, et al. Laparoscopically assisted anorectal pull through for high imperforated anus. Three Years Experience. Jour Laparendosc Adv Surg Tech 2006(16); 63-66.

11. Bhatnagar V. Assessment of postoperative results in anorectal malformations. J Indian Assoc Pediatr Surg 2005 (10); 80-84.

12. Hernández D, Palacios J. Morera C. Olza M, Jaen D. Manometría anorectal en niños con ano imperforado corregido con anorectoplastia sagital posterior. Revista de la sociedad Venezolana de Gastroenterología 2006; 14-16.