Single-incision laparoscopic-assisted anorectoplasty for treating children with intermediate-type anorectal malformations and rectobulbar fistula: a comparative study

  • Xianghai Ren
  • Hang Xu
  • Qi Jiang
  • Mei Diao
  • Xu Li
  • Long LiEmail author
Original Article



Single-incision laparoscopic-assisted anorectoplasty (SILAARP) was compared to posterior sagittal anorectoplasty (PSARP) for treating intermediate-type anorectal malformations (ARMs) with rectobulbar fistula.


Between December 2011 and January 2016, 48 children with intermediate-type ARMS were treated with SILAARP (n = 34) or PSARP (n = 14) in our centre. Data including demographics, complications, and long-term outcomes were retrospectively compared.


No significant difference was observed between both groups in terms of median operative time and complications. The length of postoperative hospital stay was shorter in the SILAARP group than in the PSARP group (6.15 ± 1.10 vs 9.64 ± 4.13 days; p = 0.008). After a mean follow-up of 59.38 ± 13.68 months, the rates of voluntary bowel movements, soiling, and constipation were similar in both groups. Anorectal manometry was performed in 15 and 7 children from the SILAARP and PSARP groups, respectively. Although there were no significant differences in the presence of rectoanal relaxation reflex and high-pressure-zone length, anal canal resting pressure was higher in the SILAARP group than in the PSARP group (33.35 ± 12.95 vs 23.06 ± 8.40 mmHg; p = 0.039).


Both SILAARP and PSARP seemed feasible and effective for treating intermediate-type ARMs with rectobulbar fistula in children. However, SILAARP significantly reduced the length of postoperative hospital stay and improved anal canal resting pressure.


Laparoscopy-assisted anorectoplasty Posterior sagittal anorectoplasty Anorectal malformations Levator ani Terminal rectum 




Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to disclose.

Research involving human participants

Ethical approval was obtained from the Ethics Committee of the Capital Institute of Pediatrics.

Informed consent

Written informed consents were obtained from the parents before anorectoplasty.


  1. 1.
    Kovacic K, Matta SR, Kovacic K, Calkins C, Yan K, Sood MR (2018) Healthcare utilization and comorbidities associated with anorectal malformations in the united states. J Pediatr 194:142–146. CrossRefGoogle Scholar
  2. 2.
    Wigander H, Nisell M, Björn Frenckner, Wester T, Brodin U, Maria Öjmyr-Joelsson (2019) Quality of life and functional outcome in swedish children with low anorectal malformations: a follow-up study. Pediatr Surg Int 35:583–590. CrossRefGoogle Scholar
  3. 3.
    Peña A, Devries PA (1982) Posterior sagittal anorectoplasty: important technical considerations and new applications. J Pediatr Surg 17:796–811. CrossRefGoogle Scholar
  4. 4.
    Georgeson KE, Inge TH, Albanese CT (2000) Laparoscopically assisted anorectal pull-through for high imperforate anus—a new technique. J Pediatr Surg 35:927–930. CrossRefGoogle Scholar
  5. 5.
    Ming AX, Li L, Diao M, Wang HB, Liu Y, Ye M, Cheng W (2014) Long term outcomes of laparoscopic-assisted anorectoplasty: a comparison study with posterior sagittal anorectoplasty. J Pediatr Surg 49:560–563. CrossRefGoogle Scholar
  6. 6.
    Ruggeri G, Destro F, Randi B, Lima M (2016) Laparoscopic-assisted anorectal pull-through for high imperforate anus: 14 years experience in a single center. J Laparoendosc Adv Surg Tech A 26:404–408. CrossRefGoogle Scholar
  7. 7.
    Bischoff A, Martinez-Leo B, Peña A (2015) Laparoscopic approach in the management of anorectal malformations. Pediatr Surg Int 31:431–437. CrossRefGoogle Scholar
  8. 8.
    Koga H, Okazaki T, Yamataka A, Kobayashi H, Yanai T, Lane GJ, Miyano T (2005) Posterior urethral diverticulum after laparoscopic-assisted repair of high-type anorectal malformation in a male patient: surgical treatment and prevention. Pediatr Surg Int 21:58–60. CrossRefGoogle Scholar
  9. 9.
    Alam S, Lawal TA, Peña A, Sheldon C, Levitt MA (2011) Acquired posterior urethral diverticulum following surgery for anorectal malformations. J Pediatr Surg 46:1231–1235. CrossRefGoogle Scholar
  10. 10.
    Ren X, Xiao H, Li L, Diao M, Chen L, Zhou R, Li H, Li X, Cheng W (2018) Single-incision laparoscopic-assisted anorectoplasty versus three-port laparoscopy in treatment of persistent cloaca: a midterm follow-up. J Laparoendosc Adv Surg Tech A 28:1540–1547. CrossRefGoogle Scholar
  11. 11.
    Diao M, Li L, Guan KP, Zhang Z, Cheng W (2017) A novel laparoscopic technique for anorectal malformation with low recto-bulbar fistulae. Surg Endosc 31:4326–4330. CrossRefGoogle Scholar
  12. 12.
    Stephens FD, Smith ED, Paoul NW (1988) Anorectal malformations in children: update 1988 March of Dimes Birth Defect Foundation Original series, vol 24(4). Alan R. Liss Inc, New YorkGoogle Scholar
  13. 13.
    Holschneider A, Hutson J, Peña A et al (2005) Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations. J Pediatr Surg 40:1521–1526. CrossRefGoogle Scholar
  14. 14.
    Wang C, Diao M, Li L, Liu S, Chen Z, Li X, Cheng W (2017) Laparoscopic dissection and division of distal fistula in boys with rectourethral fistula. J Surg Res 211:147–153. (Epub 2016 Dec 11) CrossRefGoogle Scholar
  15. 15.
    Diao M, Li L, Ye M, Cheng W (2014) Single-incision laparoscopic-assisted anorectoplasty using conventional instruments for children with anorectal malformations and rectourethral or rectovesical fistula. J Pediatr Surg 49:1689–1694. CrossRefGoogle Scholar
  16. 16.
    deVries PA, Peña A (1982) Posterior sagittal anorectoplasty. J Pediatr Surg 17:638–643. CrossRefGoogle Scholar
  17. 17.
    De Vos C, Arnold M, Sidler D, Moore SW (2011) A comparison of laparoscopic-assisted (LAARP) and posterior sagittal (PSARP) anorectoplasty in the outcome of intermediate and high anorectal malformations: gastro-intestinal. S Afr J Surg 49:39–43. Google Scholar
  18. 18.
    Wong KK, Wu X, Chan IH, Tam PK (2011) Evaluation of defecative function 5 years or longer after laparoscopic-assisted pull-through for imperforate anus. J Pediatr Surg 46:2313–2315. CrossRefGoogle Scholar
  19. 19.
    England RJ, Warren SL, Bezuidenhout L, Numanoglu A, Millar AJ (2012) Laparoscopic repair of anorectal malformations at the Red Cross War Memorial Children’s Hospital: taking stock. J Pediatr Surg 47:565–570. CrossRefGoogle Scholar
  20. 20.
    Tainaka T, Uchida H, Tanaka Y, Hinoki A, Shirota C, Sumida W, Yokota K, Makita S, Oshima K, Chiba K, Ishimaru T, Kawashima H (2018) Long-term outcomes and complications after laparoscopic-assisted anorectoplasty vs. posterior sagittal anorectoplasty for high- and intermediate-type anorectal malformation. Pediatr Surg Int 34:1111–1116. CrossRefGoogle Scholar
  21. 21.
    Cairo SB, Rothstein DH, Harmon CM (2017) Minimally invasive surgery in the management of anorectal malformations. Clin Perinatol 44:819–834. CrossRefGoogle Scholar
  22. 22.
    Vinnicombe SJ, Good CD, Hall CM (1996) Posterior urethral diverticula: a complication of surgery for high anorectal malformations. Pediatr Radiol 26:120–126. CrossRefGoogle Scholar
  23. 23.
    Bischoff A, Peña A, Levitt MA (2013) Laparoscopic-assisted PASRP-the advantages of combining both techniques for the treatment of anorectal malformations with recto-bladderneck or high prostatic fistulas. J Pediatr Surg 48:367–371. CrossRefGoogle Scholar
  24. 24.
    Yazaki Y, Koga H, Ochi T, Okawada M, Doi T, Lane GJ, Yamataka A (2016) Surgical management of recto-prostatic and recto-bulbar anorectal malformations. Pediatr Surg Int 32:939–944. CrossRefGoogle Scholar
  25. 25.
    Yang J, Zhang W, Feng J, Guo X, Wang G, Weng Y, Sun X, Yu D (2009) Comparison of clinical outcomes and anorectal manometry in patients with congenital anorectal malformations treated with posterior sagittal anorectoplasty and laparoscopically assisted anorectal pull through. J Pediatr Surg 44:2380–2383. CrossRefGoogle Scholar
  26. 26.
    Tong QS, Tang ST, Pu JR, Mao YZ, Wang Y, Li SW, Cao QQ, Ruan QL (2011) Laparoscopically assisted anorectal pull-through for high imperforate anus in infants: intermediate results. J Pediatr Surg 46:1578–1586. CrossRefGoogle Scholar
  27. 27.
    Kudou S, Iwanaka T, Kawashima H, Uchida H, Nishi A, Yotsumoto K, Kaneko M (2005) Midterm follow-up study of high-type imperforate anus after laparoscopically assisted anorectoplasty. J Pediatr Surg 40:1923–1926. CrossRefGoogle Scholar
  28. 28.
    Han Yijiang, Xia Zhaobo, Guo Shikun, Xiangbo Yu, Li Zhongrong (2017) Laparoscopically assisted anorectal pull-through versus posterior sagittal anorectoplasty for high and intermediate anorectal malformations: a systematic review and meta-analysis. PLoS ONE 12:e0170421. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Xianghai Ren
    • 1
    • 2
  • Hang Xu
    • 2
  • Qi Jiang
    • 3
  • Mei Diao
    • 2
  • Xu Li
    • 2
  • Long Li
    • 1
    • 2
    Email author
  1. 1.Graduate School of Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingPeople’s Republic of China
  2. 2.Department of Pediatric SurgeryCapital Institute of PediatricsBeijingPeople’s Republic of China
  3. 3.Department of Pathology and Pathophysiology, Hubei Provincial Key Laboratory of Developmentally Originated Disease, School of Basic Medical SciencesWuhan UniversityWuhanPeople’s Republic of China

Personalised recommendations