Laparoscopy - Assisted Anorectoplasty for Anorectal Malformations.

Vijayagiri, D (2007) Laparoscopy - Assisted Anorectoplasty for Anorectal Malformations. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION : Posterior Sagittal Anorectoplasty (PSARP), popularized by de Vries and Pena1 has become standard surgical management of imperforate anus. The PSARP involves incision from coccyx to perineal body, to widely expose the external sphincter, the levators, the rectum, and distal fistula to facilitate surgical repair. Despite excellent exposure of the anatomy and exact placement of the distal rectum within the muscle complex, continence often is less than ideal. In an attempt to improve on these results Keith Georgeson2 et al, in 2000 described a new surgical technique Laparoscopically Assisted Anorectal Pull-Through for High Anorectal malformations (LAARP) that utilizes a laparoscopic vantage point to reduce the amount of posterior dissection required for accurate placement of the bowel into the muscle complex. In our institution3 we have been performing LAARP since 2001. The present study is intended to analyze this particular operative technique and examine the merits and demerits of this procedure. AIMS : 1. To analyze the usefulness of laparoscopy in management of High Anorectal malformations. 2. To discuss the operative technique performed in our institution. 3. To discuss various techniques described by others to identify centre of sphincter muscle complex (SMC) and placement of rectum within the centre of SMC. 4. To analyze the postoperative outcome in relation to continence, anorectal sensation & cosmetic appearance. 5. To discuss the complications related to LAARP. MATERIALS AND METHODS : Study Design: This is a retrospective and prospective study analyzing Laparoscopically Assisted Anorectal Pull-Through for High Anorectal malformations (LAARP) performed at Coimbatore Medical College Hospital. Study period: January 2001 to March 2007. Study center: Study carried out at the Department of Paediatric surgery, Coimbatore Medical College Hospital. Study Group: Totally 30 patients had undergone Laparoscopically Assisted Anorectal Pull-Through for Anorectal malformations (LAARP) at our department during the study period. • Male – 26 Female -4, • Age group -2 months to 6 years • TYPE of procedure, • Staged procedure – 29 patients, • Primary pull through – 1 child. (Recto vestibular fistula at 5 months of age) CONCLUSION : 1. LAARP provides excellent visualization of the rectal fistula and surrounding structures. 2. In our experience dividing the fistula without ligation is safe. 3. Allows accurate placement of the bowel through the anatomical midline and levator sling. 4. Early postoperative recovery, early ambulance & decreased pain to the patient are seen in LAARP patients. 5. Repair of associated defect at operation (i.e., hernia, Identification and repair of cryptorchid testes) is possible. 6. It is minimally invasive and leaves small abdominal & perineal wounds. 7. We have found LAARP is an alternative and more effective technique for high ARM over conventional methods. 8. Earlier appearance & higher incidence of recto anal relaxation reflex is noted in LAARP patients. 9. Long term follow up is essential for evaluation of final results.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Laparoscopy ; Assisted Anorectoplasty ; Anorectal Malformations.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 31 Jul 2017 04:10
Last Modified: 31 Jul 2017 04:10

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